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Utility of colonic manometry in children with Hirschsprung disease
Yinan Fu1, Christopher Gayer2, Michelle Gould1
1Department of Pediatric Gastroenterology, Children's Hospital Los Angeles, Los Angeles, California, USA.
Insights
Colonic manometry (CM) helps manage defecation issues in post-pull-through Hirschsprung disease (PT-HSCR) patients. Optimizing medical care before CM and surgery is recommended for better outcomes in PT-HSCR patients.
Area of Science:
- Pediatric surgery
- Gastroenterology
- Colorectal surgery
Background:
- Post-pull-through Hirschsprung disease (PT-HSCR) patients often experience persistent defecation problems.
- Abnormal residual colon motility is a suspected cause in these patients.
Purpose of the Study:
- To review the utility of colonic manometry (CM) in managing defecation disorders in PT-HSCR patients.
- To correlate CM findings with clinical outcomes.
Main Methods:
- Retrospective review of medical records of PT-HSCR children who underwent CM for abnormal defecation.
- Analysis of clinical course in relation to CM findings.
Main Results:
- Of 25 evaluable PT-HSCR patients, 16 showed colonic dysmotility, 8 had normal CM, and 1 had hypermotility.
- Outcomes varied, with some patients responding to medical management, others requiring surgery, and some lost to follow-up.
- CM findings aided in guiding management decisions.
Conclusions:
- Colonic dysmotility is a significant factor in persistent defecation issues in PT-HSCR.
- CM effectively assesses colonic neuromuscular function in these patients.
- Optimizing medical management prior to considering CM and surgical interventions is crucial.
Objectives:
Abnormal motility of the residual colon has been reported in post-pull-through Hirschsprung disease (PT-HSCR) patients with persistent defecation problems. We reviewed the role of colonic manometry (CM) in the management of defecation disorders in these patients.
Methods:
We retrospectively reviewed the medical record of PT-HSCR children who underwent CM for persistent symptoms of abnormal defecation. We reviewed their clinical course and its relation to CM findings.
Results:
Thirty PT-HSCR patients underwent CM, of which five were diagnosed with transition zone pull-through and were excluded. Of the remaining 25 patients, 16 had colonic dysmotility, 8 had normal CM, and one had colonic hypermotility. In patients with dysmotility, five responded to ongoing medical management, three required surgical intervention (ileostomy), three remained symptomatic with medical management but not yet received surgical intervention, and five were lost to follow-up. In patients with normal CM, four responded to ongoing medical therapy, two required additional surgery (antegrade enema procedure), and two were lost to follow-up. The patient with hypermotility improved with adding loperamide.
Conclusions:
Colonic dysmotility can occur in PT-HSCR patients with persistent defecation problems. CM was helpful in delineating the degree of colonic neuromuscular dysfunction. CM results were used in conjunction with other clinical data to determine optimal management. Our findings support that medical management should first be optimized before consideration of colonic manometry and surgical interventions.
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