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Rectoanal pressures and rectal compliance in constipated infants and children
Insights
Anorectal manometry can differentiate Hirschsprung's disease from chronic constipation in children. Hirschsprung's disease shows specific manometric abnormalities, while chronic constipation with megarectum indicates high rectal compliance.
Area of Science:
- Pediatric Gastroenterology
- Physiology
- Diagnostic Medicine
Background:
- Anorectal manometry is crucial for diagnosing functional gastrointestinal disorders in children.
- Differentiating Hirschsprung's disease from functional constipation is essential for appropriate treatment.
- Rectal compliance and pressure-volume relationships offer insights into anorectal function.
Purpose of the Study:
- To evaluate the utility of anorectal manometry in distinguishing Hirschsprung's disease from idiopathic chronic constipation in infants and children.
- To characterize specific manometric findings associated with Hirschsprung's disease and chronic constipation, including megarectum.
Main Methods:
- Anorectal manometry using a perfused side-opening catheter was performed on 86 normal children, 9 infants with Hirschsprung's disease, and 10 with chronic constipation.
- Pressure-volume curves and rectal compliance were assessed in subsets of these groups.
Main Results:
- Infants with Hirschsprung's disease exhibited decreased basal anal canal contractions, absent recto-anal reflex, steep rectal pressure-volume curves, and low rectal compliance.
- Chronically constipated children without megarectum showed normal anorectal pressure profiles, recto-anal reflex, pressure-volume curves, and rectal compliance.
- Children with chronic constipation and megarectum demonstrated remarkably high rectal compliance.
Conclusions:
- Anorectal manometry provides distinct diagnostic features for Hirschsprung's disease, characterized by impaired recto-anal reflex and low rectal compliance.
- High rectal compliance is a key finding in children with chronic constipation and megarectum, differentiating it from Hirschsprung's disease.
Abstract:
Anorectal manometry with perfused side opening catheter was carried out in 86 normal infants and children, 9 infants with Hirschsprung's disease, and 10 children with idiopathic chronic constipation. Studies on pressure volume curve of the rectum and rectal compliance were carried out in 37 normal infants and children, 4 infants with Hirschsprung's disease, and 10 children with idiopathic chronic constipation. Decreased basal rhythmic contraction of the anal canal, absent recto-anal reflex, steep elevation of pressure volume curve of the rectum, and low rectal compliance were characteristic of infants with Hirschsprung's disease. Resting pressure profile of the anorectum, recto-anal reflex, pressure volume curve of the rectum, and rectal compliance were normal in chronically constipated children without megarectum, whereas remarkably high rectal compliance was characteristic of those with megarectum.