SEGMENTAL COLONIC MOTILITY IN PATIENTS WITH ANORECTAL-MALFORMATIONS

Citation
Rj. Rintala et al., SEGMENTAL COLONIC MOTILITY IN PATIENTS WITH ANORECTAL-MALFORMATIONS, Journal of pediatric surgery, 32(3), 1997, pp. 453-456
Citations number
19
Language
INGLESE
art.tipo
Article
Categorie Soggetti
Pediatrics,Surgery
ISSN journal
0022-3468
Volume
32
Issue
3
Year of publication
1997
Pages
453 - 456
Database
ISI
SICI code
0022-3468(1997)32:3<453:SCMIPW>2.0.ZU;2-X
Abstract
Background: Constipation is one of the most important functional seque lae in patients with anorectal malformations. The cause of this motili ty disorder is unknown. Aim: The purpose of this study was to assess t otal colonic transit time (TCT) and segmental colonic transit time (SC T) in patients with anorectal malformations. Method: Ninety patients w ith anorectal malformations (40 low and 50 high; median age, 7 years; range, 3 to 13) and twenty-five healthy children (median age, 8 years; range, 3 to 14 years) underwent measurement of TCT and SCT by the sat uration technique. Ten radiopaque markers were ingested daily for 6 da ys followed by administration of a single abdominal x-ray on day 7. TC T in days was calculated by dividing the number of retained markers in the whole colon by the daily intake. SCT in four colonic segments (ri ght, transverse, left, rectosigmoid) was described as a percentage of TCT (markers in one segment versus total number of retained markers). In high anomalies the degree of rectosigmoid dilatation was assessed b y contrast enemas taken before closure of the stoma and later during f ollow-up. Results: TCT was significantly (P < .03) prolonged in patien ts with anorectal anomalies (median high, 2.1 days; low, 1.9 days vers us 1.3 in healthy subjects). In patients with high anomalies right SCT was prolonged when compared with low anomalies and healthy subjects ( median high, 24% versus low, 10% and normal subjects, 10%; P < .01). T he impairment was more severe in patients with very high anomalies (P < .005), Patients with a low anomaly had prolonged rectosigmoid SCT (m edian low, 65% versus high, 43% and normal subjects, 49%; P < .05). Pr olonged right colonic SCT and TCT correlated with symptomatic constipa tion in patients with high anomalies (P < .05) but not with those who had low anomalies, Impaired overall functional outcome correlated with prolonged right colonic SCT in patients with high anomalies and with prolonged rectosigmoid SCT in patients with low anomalies. There was n o correlation between the degree of rectosigmoid dilatation and SCT or TCT. Conclusion: Patients with anorectal malformations have abnormal colonic motility. The type of motility disorder in low anomalies is re ctosigmoid hypomotility. In patients with high anomalies the motility disturbance is more generalized. The overall functional outcome was st rongly related to the degree of these motility disorders. Copyright (C ) 1997 by W.B. Saunders Company.