BATTINI,DOMENICO AND HIS DESCRIPTION OF CONGENITAL MEGACOLON - A DETAILED CASE-REPORT ONE CENTURY BEFORE HIRSCHSPRUNG

More than one century after the epochal paper of Harald Hirschsprung, and in spite of fast and remarkable advances in the pathophysiology of congenital megacolon, our understanding of how bowels may become func tionally obstructed, and especially its variability, remains largely i ncomplete. While much more needs to be known about normal gastrointest inal physiology, an interaction between genetic and environmental fact ors seems to be of paramount importance in the pathogenesis of Hirschs prung's disease. While reviewing the relevant literature, we came acro ss a virtually unknown contribution by an Italian physician, Domenico Battini, who happened to follow-up for about 10 years a case of severe constipation. This contribution, published posthumously as a book in 1800, not only describes very carefully the clinical evolution of that patient, but also provides a detailed post-mortem examination of the abdominal viscera, with particular reference to the alterations occurr ed in the intestines. We conclude that Battini, nearly one century bef ore Hirschsprung, had succeeded in reporting a typical case of congeni tal megacolon, and had perceived a number of features (familiarity, se lective involvement of ''neural layers'' in the gut mucosa) that were to become characteristic of Hirschsprung's disease a few decades after Hirschsprung himself had published his article.