title: Evaluation of dysfunction following reconstruction of an anorectal anomaly.
abstract: To evaluate the utility of anorectal manometry (ARM) and magnetic resonance imaging (MRI) with an endocoil in the assessment of dysfunction in children with repaired anorectal anomalies (ARA), 15 patients aged 1 to 15 years with repaired ARAs and chronic faecal incontinence or constipation were prospectively recruited. They underwent clinical assessment using a modified Wingfield score (MWS). ARM and MRI with an endocoil and conventional external coil were carried out. The results of ARM alone, MRI alone, and a combination of ARM and MRI were correlated with the MWS. Manometric internal anal sphincter (IAS) scores determined from sphincter length and activity correlated with MWS (r = 0.56, P = 0.02); manometric scores of rectal peristaltic activity did not. Overall manometric score (IAS and rectal scores combined) showed a correlation with MWS (r = 0.55, P = 0.02). Endoanal MRI sphincter scores did not correlate with MWS, but the presence of a megarectum on MRI did (r = 0.44, P = 0.05). Overall MRI score did not correlate with MWS. Minor neurosacral anomalies were shown on MRI in 3 children who had poor functional scores. Combined manometric and MRI scores showed a correlation with MWS (r = 0.58, P = 0.01). ARM and MRI are potentially useful in the assessment of dysfunction of children with repaired ARAs. Both modalities require refinement and further assessment in the context of directing management.
authors.affiliation: Department of Paediatric Surgery and Paediatrics, Guy's and St Thomas' NHS Trust, University Hospital Lewisham, UK.
authors.forename: M
authors.initials: M
authors.lastname: Hettiarachchi
authors.forename: G
authors.initials: G
authors.lastname: Garcea
authors.forename: N M
authors.initials: NM
authors.lastname: deSouza
authors.forename: A D
authors.initials: AD
authors.lastname: Williams
authors.forename: G S
authors.initials: GS
authors.lastname: Clayden
authors.forename: H C
authors.initials: HC
authors.lastname: Ward
mesh_terms: D000293:Adolescent; D000328:Adult; D001003:Anal Canal / Q000002:abnormalities*; D002648:Child; D002675:Child, Preschool; D013505:Digestive System Surgical Procedures; D005260:Female; D006801:Humans; D007223:Infant; D008279:Magnetic Resonance Imaging; D008297:Male; D008365:Manometry; D011184:Postoperative Period; D011446:Prospective Studies; D019651:Plastic Surgery Procedures; D012007:Rectum / Q000002:abnormalities* / Q000503:physiopathology