Anorectal sleeve micromanometry for the diagnosis of Hirschsprung's disease in newborns.
OBJECTIVE
An accurate diagnosis is mandatory for surgery in newborns with Hirschsprung's disease (HD). Acetylcholinesterase staining of rectal suction biopsy specimens is widely performed in the diagnosis of HD, but results are sometimes incorrect or atypical in newborns. We report the usefulness of our method of anorectal manometry using a specially designed sleeve microassembly for the diagnosis of neonatal HD.


METHODS
Anorectal manometry was conducted without sedation in 41 newborns, aged 2 to 30 days (19 newborns were within the first week of life), with abdominal distension. A silastic assembly with a 2-cm-long sleeve sensor and 5 side holes arrayed along the sleeve was designed to reduce the effects of displacement of pressure sensors relative to the anal sphincter. Rectoanal inhibitory reflex (RAIR) was examined with rectal balloon distension.


RESULTS
Thirty-two subjects who showed falls of anal sphincter pressure fulfilling the criteria for RAIR were diagnosed to be without HD. Nine patients without an appropriate RAIR were subsequently confirmed to have HD based on operative pathologic findings. Parameters of anal sphincter function did not differ significantly between the subjects with and without RAIR.


CONCLUSIONS
An anorectal sleeve micromanometric technique is useful in the diagnostic workup of newborns suspected of having HD.
Kawahara
Hisayoshi
H
Department of Pediatric Surgery, Osaka Medical Center and Research Institute for Maternal and Child Health, Osaka 594-1101, Japan. kawahara@mch.pref.osaka.jp
Kubota
Akio
A
Hasegawa
Toshimichi
T
Okuyama
Hiroomi
H
Ueno
Takehisa
T
Watanabe
Takashi
T
Morishita
Yuji
Y
Saka
Ryuta
R
Fukuzawa
Masahiro
M
D001003:Anal Canal / Q000294:innervation / Q000503:physiopathology*; D001707:Biopsy, Needle; D015331:Cohort Studies; D042241:Early Diagnosis; D005260:Female; D006627:Hirschsprung Disease / Q000175:diagnosis* / Q000601:surgery; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D008365:Manometry / Q000379:methods*; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index