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Published on: April 26, 2019

Topical application of isosorbide dinitrate in patients with persistent constipation after pull-through surgery for

M Messina1, G Amato, D Meucci

  • 1Section of Pediatric Surgery, Department of Pediatrics, Obstetrics and Reproductive Medicine, University of Siena, Siena, Italy. messinam@unisi.it

European Journal of Pediatric Surgery : Official Journal of Austrian Association of Pediatric Surgery ... [Et Al] = Zeitschrift Fur Kinderchirurgie
|April 5, 2007
PubMed

Insights

Topical isosorbide dinitrate (ISDN) improved constipation in children post-Hirschsprung

Area of Science:

  • Pediatric Surgery
  • Gastroenterology
  • Pharmacology

Background:

  • Hirschsprung's disease (HD) is a congenital disorder requiring surgical correction, often followed by persistent constipation.
  • Pull-through surgery for HD can lead to residual anal manometric abnormalities and clinical constipation.
  • Current treatment options for post-surgical constipation in HD may be limited or invasive.

Observation:

  • This study evaluated 3 pediatric patients with persistent constipation after Soave-Boley pull-through surgery for HD.
  • Patients received topical isosorbide dinitrate (ISDN) paste (1 mg/kg twice daily) for three weeks.
  • Anorectal manometry and clinical symptoms were assessed pre- and post-treatment, with follow-up at 1, 3, and 6 months.

Findings:

  • Topical ISDN treatment resulted in significant improvement in constipation symptoms, with patients averaging 4 spontaneous evacuations weekly.
  • Anorectal manometry showed a marked decrease in anal pressures: medium pressure reduced by 54.4% and maximum pressure by 38.7%.
  • The high-pressure zone length decreased by 11.1%, indicating improved anal relaxation post-ISDN application.

Implications:

  • Topical ISDN presents a potential non-invasive therapeutic alternative to anal myotomy for managing persistent constipation after HD surgery.
  • The observed manometric improvements suggest ISDN effectively reduces anal sphincter tone in this patient population.
  • Further research with larger cohorts and extended follow-up is warranted to confirm ISDN's long-term efficacy and safety.
Abstract

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