Domenico Battini 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 functionally obstructed, and especially its variability, remains largely incomplete. While much more needs to be known about normal gastrointestinal physiology, an interaction between genetic and environmental factors seems to be of paramount importance in the pathogenesis of Hirschsprung's disease. While reviewing the relevant literature, we came across 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 occurred in the intestines. We conclude that Battini, nearly one century before Hirschsprung, had succeeded in reporting a typical case of congenital megacolon, and had perceived a number of features (familiarity, selective 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.