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[Functional disorders of distal colon in children (author's transl)]
Insights
Diagnosing distal colon disorders in infants requires multiple methods, with manometry being most effective. Treatment varies from conservative measures to surgery based on the specific condition diagnosed.
Area of Science:
- Pediatric Gastroenterology
- Colorectal Surgery
- Diagnostic Imaging
Context:
- Functional disorders of the distal colon are common in neonates and infants.
- Accurate diagnosis is crucial for effective management and preventing complications.
Purpose:
- To outline diagnostic modalities for distal colon disorders in infants.
- To correlate diagnostic methods with their diagnostic yield.
- To guide treatment strategies based on diagnosis.
Summary:
- Diagnostic tools include X-ray investigations (defecograms), double-suction biopsies, anorectal and sigmoidal manometry, and coloscopic functional investigations.
- Manometric studies achieve a 90% diagnostic rate for distal colon disorders, while X-rays yield 40%, double-suction biopsies 12%, and coloscopy 10%.
- Double-suction biopsy is vital for excluding aganglionosis. Treatment options range from conservative approaches (washouts, training) to surgical interventions (sphincterotomy, resection) depending on the underlying pathology.
Impact:
- Establishes a diagnostic hierarchy for pediatric distal colon functional disorders.
- Informs clinical decision-making for appropriate and timely treatment.
- Improves patient outcomes by ensuring accurate diagnosis and tailored therapy.
Abstract:
Functional disorders of the distal part of the colon in neonates and infants should be diagnosed by X-ray investigations (defecograms), double-suction biopsies (Erlanger children suction biopsy apparatus), anorectal and sigmoidal manometry and coloscopic functional investigations. 90% of all disorders of the distal colon can be diagnosed by manometric studies, in 40% X-ray investigations will lead to an exact diagnosis, in 12% double suction biopsies and in 10% coloscopic investigations establish the right diagnosis. The double suction biopsy is important for the exclusion of aganglionosis. Either a conservative or a surgical treatment is necessary, depending on the primary lesion. Wash outs, sphinctertraining, toilet training are necessary in cases of prolonged constipation following sigmaresection with restmegacolon, in cases of rectal inertia syndrom, and in cases of overflow incontinence. A pressure reducing operation (a sphincteromyotomy) is indicated in ultrashort aganglionic segments, in special cases of elongated sigma, in cases of prolonged constipation after sigma resection and with disturbed reflex mechanism, in cases of sphincter inhibition syndrome, and in children with paradox reflex mechanism. A resection is indicated in Hirschsprung disease, mechanical obstruction of the bowel, very large and severe cases of sigma elongatum and in cases of overflow-incontinence.