Colonic manometry via appendicostomy shows reduced frequency, amplitude, and length of propagating sequences in children with slow-transit constipation

doi:10.1016/j.jpedsurg.2005.03.047

Journal of Pediatric Surgery

Volume 40, Issue 7, July 2005, Pages 1138-1145

https://doi.org/10.1016/j.jpedsurg.2005.03.047 Get rights and content

Abstract

Background/Purpose

We wish to define colonic motor function in children with slow-transit constipation (STC) using manometry catheters introduced through appendiceal stomas, previously sited for controlling fecal retention by colonic irrigation.

Methods

We undertook 24-hour pancolonic manometry of 6 children (5 boys; mean, 11.5 years; SD, 3.0) using a multilumen silastic catheter. Results were compared to nasocolonic motility studies obtained in healthy young adults.

Results

Antegrade propagating sequences (APSs) originated less frequently in the cecum compared to controls. There were fewer APS (mean ± SEM: STC, 13 ± 6 per 24 hours; controls, 52 ± 6 per 24 hours; P < .01) and high-amplitude propagating contractions (HAPCs: STC, 5 ± 2 per 24 hours; controls, 9.9 ± 1.4 per 24 hours; P < .05). The amplitude of APS and HAPC was less in STC (APS, 39 ± 9 mm Hg; controls, 54 ± 3 per 24 hours; P < .05) (HAPC: STC, 94 ± 10 mm Hg; control, 117 ± 3 mm Hg; P < .01), whereas the amplitude of retrograde propagating sequences was greater in STC (43 ± 6 mm Hg; control, 27 ± 1 mm Hg; P < .01). The distances propagated by HAPC were significantly less in STC (36 ± 4.5 vs 47 ± 2.3 cm, controls; P < .05), and there was no evidence of a region-specific difference in propagation velocity of APS. Neither meal ingestion nor waking significantly increased colonic motor activity in patients with STC.

Conclusions

Despite the small numbers available to be studied, we found that children with STC in whom an appendicostomy had been placed show significant abnormalities in pancolonic motor function.

Section snippets

Patient selection

We contacted the parents of 40 sequential children who had undergone appendicostomy formation for treatment-resistant constipation and soiling with STC through the Department of General Surgery at the Royal Children's Hospital, Melbourne, Australia. All had been operated upon at least 6 months previously. Six children and their parents agreed to participate in the study. Their mean age was 11.5 years (range, 8-16 years) and 5 of the 6 were boys. Slow colonic transit was defined on scintigraphic

Catheter placement and recording times

The catheter tip was located in the distal sigmoid colon in 5 of the 6 patients (Fig. 1). In Fig. 1 (number 4 side hole), the catheter only progressed as far as the splenic flexure. No child experienced significant discomfort or requested analgesia during or after catheter insertion or removal. No complications were associated with these procedures.

Frequency of PS in STC

Antegrade PS and HAPC were significantly less frequent in STC children than controls (Table 1). One patient had little activity with no antegrade or

Discussion

To our knowledge, this is the first study to evaluate prolonged right-sided colonic motor activity in children with well-defined STC. This was made possible by the presence of an established appendicostomy, and so the technique is not applicable to routine diagnostic evaluation of severe constipation. A limitation in the normal measurement of colonic motor activity in children is that catheters that are inserted during colonoscopy [10] are often unable to be placed or maintained in the right

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Original articleColonic manometry via appendicostomy shows reduced frequency, amplitude, and length of propagating sequences in children with slow-transit constipation

Abstract

Background/Purpose

Methods

Results

Conclusions

Section snippets

Patient selection

Catheter placement and recording times

Frequency of PS in STC

Discussion

Gastroenterology

Am J Gastroenterol

Gastroenterology

Am J Gastroenterol

J Pediatr Surg

J Pediatr Surg

J Pediatr Surg

J Pediatr Surg

Int J Pharm

Gastroenterology

Gastroenterology

Encopresis

Curr Opin Pediatr

Colonic transit time in constipated children: does pediatric slow-transit constipation exist?

J Pediatr Gastroenterol Nutr

Childhood functional gastrointestinal disorders

Gut

Relationships between spatial patterns of colonic pressure and individual movements of content

Am J Physiol Gastrointest Liver Physiol

Manometric investigation of high-amplitude propagated contractile activity of the human colon

Am J Physiol

Colonic mass movements in idiopathic chronic constipation

Gut

Original article
Colonic manometry via appendicostomy shows reduced frequency, amplitude, and length of propagating sequences in children with slow-transit constipation