Colonic manometry as predictor of cecostomy success in children with defecation disorders.
OBJECTIVE
The aim of this study was to define the predictive value of colonic manometry and contrast enema before cecostomy placement in children with defecation disorders.


METHODS
Medical records, contrast enema, and colonic manometry studies were reviewed for 32 children with defecation disorders who underwent cecostomy placement between 1999 and 2004. Diagnoses included idiopathic constipation (n = 13), Hirschsprung's disease (n = 2), cerebral palsy (n = 1), imperforate anus (n = 6), spinal abnormality (n = 6), and anal with spinal abnormality (n = 4). Contrast enemas were evaluated for the presence of anatomic abnormalities and the degree of colonic dilatation. Colonic manometry was considered normal when high-amplitude propagating contractions (HAPC) occurred from proximal to distal colon. Clinical success was defined as normal defecation frequency with no or occasional fecal incontinence.


RESULTS
Colonic manometry was done on 32 and contrast enema on 24 patients before cecostomy. At follow-up, 25 patients (78%) fulfilled the success criteria. Absence of HAPC throughout the colon was related to unsuccessful outcome (P = .03). Colonic response with normal HAPC after bisacodyl administration was predictive of success (P = .03). Presence of colonic dilatation was not associated with colonic dysmotility.


CONCLUSIONS
Colonic manometry is helpful in predicting the outcome after cecostomy. Patients with generalized colonic dysmotility are less likely to benefit from use of antegrade enemas via cecostomy. Normal colonic response to bisacodyl predicts favorable outcome.
Division of Gastroenterology, Department of Pediatrics, The Ohio State University College of Medicine and Public Health, Columbus, OH 43205, USA.
Maartje M
MM
van den Berg
Mark
M
Hogan
Donna A
DA
Caniano
Carlo
C
Di Lorenzo
Marc A
MA
Benninga
Hayat M
HM
Mousa
D000293:Adolescent; D002431:Cecostomy; D002648:Child; D002675:Child, Preschool; D003106:Colon / Q000503:physiopathology*; D003108:Colonic Diseases / Q000175:diagnosis / Q000503:physiopathology* / Q000601:surgery*; D004108:Dilatation, Pathologic; D004733:Enema; D005242:Fecal Incontinence / Q000503:physiopathology* / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008365:Manometry; D011237:Predictive Value of Tests; D012074:Remission Induction; D012189:Retrospective Studies