A new study published in Neurogastroenterology and Motility assessed the presence and the characteristics of the colo-anal reflex in children in whom large bowel continuity had been surgically disrupted, in order to assess the role of the extrinsic nervous system in the reflex. This was a retrospective study wherein high-resolution (HR) colonic manometry and HR-anorectal manometry were used to evaluate colonic and anal motor activity in 10 children with treatment-unresponsive slow transit constipation (STC), who had previously undergone left-sided colostomy formation with consequent disruption of the bowel continuity, and in additional two children with Hirschsprungs disease (HSCR), who had previously undergone distal colon resection followed by Duhamel pull-through. While 8 children with STC, normal colonic motor activity, and preserved large bowel continuity formed the control group. The presence and characteristics of colo-anal reflex were analyzed. It was noted that all children in the study group exhibited both, normal high amplitude propagating contractions (HAPCs) and the presence of the colo-anal reflex. Meanwhile, in two cases of HSCR, recto-anal inhibitory reflex (RAIR) was absent, but both patients demonstrated a colo-anal reflex. The findings indicated that in children with disrupted continuity of the colon and/or abnormal anal reflex, the colo-anal reflex is preserved suggesting that it is mediated by a different pathway from the RAIR, possibly an extrinsic neural pathway.