Total colonic manometry as a guide for surgical management of functional colonic obstruction: Preliminary results

• Published in: Journal of pediatric surgery 2001-12, Vol.36 (12), p.1757-1763
• Main Authors: Martin, Matthew J., Steele, Scott R., Noel, James M., Weichmann, David, Azarow, Kenneth S.
• Format: Article
• Language: English
• Subjects: Barium Sulfate; Biological and medical sciences; Biopsy; Colon - physiology; Colonic Diseases, Functional - diagnosis; Colonic Diseases, Functional - surgery; colonic manometry; Colonoscopy; Enema; Feasibility Studies; Female; Follow-Up Studies; Functional colonic obstruction; Hirschsprung Disease - diagnosis; Hirschsprung Disease - surgery; Hirschsprung's disease; Humans; Infant, Newborn; Intestinal Obstruction - diagnosis; Intestinal Obstruction - surgery; Male; Manometry - methods; Manometry - statistics & numerical data; Medical sciences; pseudo-obstruction; Retrospective Studies; Stomach, duodenum, intestine, rectum, anus; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Treatment Outcome
• ISSN: 0022-3468; 1531-5037
• DOI: 10.1053/jpsu.2001.28815

Background/Purpose: Functional colonic obstruction (pseudo-obstruction) encompasses a broad group of motility disorders. Medical management of colonic pseudo-obstruction is complex and often fails, leading to surgical referral. In most cases (excepting Hirschsprung's disease) the surgeon is unable to precisely localize the area of functional obstruction. Total colonic manometry can directly measure intraluminal pressures and contractile function along the entire length of the colon. The authors propose that total colonic manometry can be used by the pediatric surgeon to guide the timing and extent of surgical therapy in refractory functional colonic obstruction. Methods: Four patients were evaluated for functional colonic obstruction. All underwent barium enema and rectal biopsy with a diagnosis of Hirschsprung's disease in one patient. All patients underwent colonoscopy and total colonic manometry. Manometric tracings were obtained while fasting, after feeding, and after pharmacologic stimulation both preoperatively (n = 4) and postoperatively (n = 3). Results: Total colonic manometry identified an abrupt end of normal peristalsis in 2 of the non-Hirschsprung's patients (one in the proximal colon and one in the transverse colon). Medical therapy failed in both of these patients, and they underwent diverting ostomy proximal to the loss of normal peristalsis. The third non-Hirschsprung's patient essentially had normal manometry and was able to have her colon decompressed successfully on a laxative regimen. Repeat manometry after colonic decompression showed return of normal peristalsis in 2 of these patients and continued abnormal peristaltic activity in the third. Definitive surgical intervention based on the results of total colonic manometry was performed on the latter. All 3 patients achieved normal continence. A fourth patient had Hirschsprung's disease confirmed by rectal biopsy and underwent a 1-stage neonatal modified Duhamel procedure, which was complicated by postoperative functional obstruction. Manometry showed a lack of peristaltic function beginning in the right colon. An ileostomy was performed, and timing of ileostomy closure was guided by the return of normal colonic peristalsis seen on manometry. Conclusions: These initial cases show the utility of total colonic manometry in the management of colonic pseudo-obstruction syndromes. In addition to its diagnostic utility, direct measurement of colonic motor activity can be valuable in deciding