Adult Hirschsprung's disease. An experience with the Duhamel-Martin procedure with special reference to obstructed patients.

A two-stage management of six adult patients with Hirschsprung's disease of the rectum and rectosigmoid, with obstruction (two patients) or enormous dilatation of the proximal innervated colon is reported. A preliminary transverse loop colostomy was carried out urgently in two patients because of colonic obstruction, and electively in four patients; at the same time, a full-thickness rectal wall biopsy was taken in all patients to establish the diagnosis. Reconstruction was performed four to six months later with Martin's modification of the Duhamel procedure. The postoperative course was uneventful and functional results are excellent three to eight years later. Based on experience, the Duhamel-Martin procedure seems preferable in adult Hirschsprung's disease when a considerable discrepancy exists between the ganglionic and aganglionic segments of the colorectum.