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Abstract

Following surgical correction of imperforate anus, voluntary bowel control is frequently poor because of abnormal anorectal function. Using colonic manometry we investigated the role of colonic motility in the pathogenesis of fecal soiling in children following imperforate anus repair. Thirteen children with repaired imperforate anus and fecal soiling underwent motility testing 2-12 years after anoplasty. All had fecal incontinence unresponsive to conventional medical treatment. Colonic manometry was performed using water-perfused catheters. Anorectal manometry was undertaken in 10 patients. Motility study results, treatment and outcomes were compared. All patients had high-amplitude propagating contractions (HAPCs) with an average of 80% propagation into the neorectum. There was no correlation between HAPC number or morphology and any variable. Internal anal sphincter resting pressure was low in 6/10 patients. Relaxation of the internal anal sphincter was present in 6/10 children. Only 1 of 5 patients able to cooperate was capable of generating a normal maximal squeeze pressure. Therapeutic regimens were changed in 11 patients with clinical improvement in five. Fecal soiling in patients with repaired imperforate anus is a multifactorial problem including propagation of excessive numbers of HAPCs into the neorectum as well as internal anal sphincter dysfunction. Colonic manometry in conjunction with anorectal manometry aids in the understanding of the pathophysiology of fecal soiling and guides clinical management in children with repaired imperforate anus.

Factors associated with successful decrease and discontinuation of antegrade continence enemas (ACE) in children with defecation disorders: a study evaluating the effect of ACE on colon motility

“…We believe that this approach can be temporary in otherwise healthy patients, as it may allow recovery of the colonic dysfunction and eventually discontinue its use, although this has not been studied. The colon manometry has been reported as useful in clinical practice to typify the colonic physiology in defecations disorders in patients with colorectal disorders like Hirschsprung’s disease [8, 9] and imperforate anus[10], to predict ACE outcome [11] and to guide surgical therapy in refractory constipation. [12, 13] However, the diagnostic value of the CM to predict outcomes has not been properly evaluated.…”

Colonic Phasic Motor Activity Is Stronger in Patients with Repaired Anorectal Malformations than Patients with Severe Colonic Dismotility

“…However, recently, new data has been obtained regarding other pediatric groups, such as repaired anorectal malformations (ARM), Hirschsprung's disease, spinal abnormality and cerebral palsy. 2–5 …”

Post‐operative colonic manometry in children with anorectal malformations: A systematic review

“…Four studies reported colonic manometry results in children with repaired ARM. 15 , 16 , 17 , 18 Colonic manometry was utilized to investigate the pathophysiology of post‐operative bowel dysfunction 15 , 16 , 18 and evaluated as a tool to predict the outcome of subsequent surgical intervention (cecostomy placement). 17 Study characteristics are summarized in Table 1 .…”

“…Three studies performed colonic manometry using water‐perfused catheters, with four to eight sensors spaced at 10–15 cm intervals. 15 , 16 , 17 Burjonrappa et al 18 did not report the colonic manometry equipment utilized. Colonic manometry specifications are summarized in Table 2 .…”

“…Three studies described the bowel preparation regimen utilized. 15 , 16 , 17 In two, colonic lavage was achieved using either sodium phosphate or polyethylene glycol, 15 or polyethylene glycol alone, 17 the day prior to the procedure. Heikenen et al 16 described an overnight fast prior to colonoscopy; however, did not report utilizing any additional medications to facilitate bowel preparation.…”