Utility of colonic manometry in children with Hirschsprung disease

Abstract

ObjectivesAbnormal 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.MethodsWe 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.ResultsThirty 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.ConclusionsColonic 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.

Colonic manometry: Still an important modality in pediatric Hirschsprung disease

“…add to the growing list of studies assessing the role of CM in patients with HD. 2,3 The current retrospective study is focused on 25 pediatric patients with HD with heterogeneous refractory defecation symptoms after definitive surgery who underwent evaluation with CM. Manometric analysis diagnosed 16 (64%) with colonic dysmotility, and one with colonic hypermotility.…”