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Colonic motility in children with repaired imperforate anus
J B Heikenen1, S L Werlin, C Di Lorenzo
1Department of Pediatrics, The Medical College of Wisconsin, Milwaukee 53226, USA.
Insights
Fecal soiling after imperforate anus repair is often due to abnormal colonic motility and internal anal sphincter dysfunction. Understanding these factors with colonic manometry helps guide treatment for better bowel control in children.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Physiology
Background:
- Voluntary bowel control is frequently impaired after surgical correction of imperforate anus due to anorectal dysfunction.
- Fecal soiling is a common and challenging issue in children post-imperforate anus repair, often unresponsive to standard treatments.
Purpose of the Study:
- To investigate the role of colonic motility in the development of fecal soiling in children following surgical repair of imperforate anus.
- To correlate colonic and anorectal manometry findings with clinical outcomes in this patient population.
Main Methods:
- Colonic manometry using water-perfused catheters was performed on 13 children with repaired imperforate anus and fecal soiling.
- Anorectal manometry was conducted in 10 of these patients.
- Motility study results were compared with treatment regimens and clinical outcomes.
Main Results:
- All patients exhibited high-amplitude propagating contractions (HAPCs) with significant propagation into the neorectum (average 80%).
- Internal anal sphincter dysfunction was noted in 6/10 patients, with low resting pressure and impaired relaxation.
- Only 1/5 cooperative patients could generate normal maximal squeeze pressure.
- Clinical improvement occurred in 5/11 patients after therapeutic regimen changes.
Conclusions:
- Fecal soiling in repaired imperforate anus cases is multifactorial, involving excessive HAPC propagation into the neorectum and internal anal sphincter dysfunction.
- Colonic and anorectal manometry are valuable tools for understanding the pathophysiology of fecal soiling and guiding management in children with repaired imperforate anus.
Abstract:
Following surgical correction of imperforate anus, voluntary bowel control is frequently poor because of abnormal anorectal function. Using colonic manometry we investigated the role of colonic motility in the pathogenesis of fecal soiling in children following imperforate anus repair. Thirteen children with repaired imperforate anus and fecal soiling underwent motility testing 2-12 years after anoplasty. All had fecal incontinence unresponsive to conventional medical treatment. Colonic manometry was performed using water-perfused catheters. Anorectal manometry was undertaken in 10 patients. Motility study results, treatment and outcomes were compared. All patients had high-amplitude propagating contractions (HAPCs) with an average of 80% propagation into the neorectum. There was no correlation between HAPC number or morphology and any variable. Internal anal sphincter resting pressure was low in 6/10 patients. Relaxation of the internal anal sphincter was present in 6/10 children. Only 1 of 5 patients able to cooperate was capable of generating a normal maximal squeeze pressure. Therapeutic regimens were changed in 11 patients with clinical improvement in five. Fecal soiling in patients with repaired imperforate anus is a multifactorial problem including propagation of excessive numbers of HAPCs into the neorectum as well as internal anal sphincter dysfunction. Colonic manometry in conjunction with anorectal manometry aids in the understanding of the pathophysiology of fecal soiling and guides clinical management in children with repaired imperforate anus.