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Colonic diversion for intractable constipation in children: colonic manometry helps guide clinical decisions
J Villarreal1, M Sood, T Zangen
1Pediatric Gastrointestinal Motility Center, Children's Hospital of Orange County, Orange, California, U.S.A.
Journal of Pediatric Gastroenterology and Nutrition
|December 12, 2001
Summary
Temporary diversion surgery improved colonic motility in children with severe constipation and dilated colons. Colonic manometry can help identify patients who may benefit from surgical interventions like resection or reanastomosis.
Area of Science:
- Pediatric Gastroenterology
- Colorectal Surgery
Background:
- Colonic manometry is crucial for differentiating functional constipation from colonic neuromuscular disease in children.
- Chronic colonic dilation can impede accurate manometric interpretation.
Purpose of the Study:
- To evaluate the efficacy of temporary diverting ostomies in improving colonic motility in children with intractable constipation and colonic dilation.
- To assess the predictive value of colonic manometry in guiding surgical interventions.
Main Methods:
- Colonic manometry was performed on 375 children; 12 with chronic dilation were selected.
- Twelve children (mean age 4 years) with ineffective medical treatment underwent diverting ostomies.
- Pathologic diagnoses included intestinal neuronal dysplasia, hypoganglionosis, and hollow visceral myopathy.
Main Results:
- After 6-30 months, 11 of 12 diverted colons were no longer dilated.
- Defecation problems resolved in 10 of 12 children post-treatment.
- Motility normalized in 4 diverted colons, leading to recommendations for reanastomosis.
Conclusions:
- Temporary diversion can improve colonic motility in select cases of intractable childhood constipation with colonic distention.
- Colonic manometry is a valuable tool for predicting surgical success in these patients.
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