Colonic transit and anorectal manometry in children with severe brain damage.

OBJECTIVE

This study was conceived to determine the physiologic abnormalities in distal gastrointestinal motility that are responsible for constipation in brain-damaged children.

DESIGN

Colonic transit and anorectal manometry were evaluated in 16 children with severe brain damage and constipation (mean age +/- SD; 5.1 +/- 3.5 years) and the results were compared with findings in 15 age- and sex-matched children with functional fecal retention and normal mental development. Anorectal motility findings also were compared with those from 11 asymptomatic children. The progress of radiopaque markers, as determined by sequential plain abdominal radiographs, was used to evaluate segmental colonic transit times.

RESULTS

In children with brain damage, colonic transit was prolonged at the level of left colon in 18.8% of the patients, at both left colon and rectum in 56.2%, and at rectum only in 25%. These findings differed (P < .05) from those in children with functional fecal retention wherein transit was prolonged in the left colon and rectum in 20% of the patients and the rectum only in 80%. By anorectal manometry, no significant intergroup differences were detected in anal pressures and in the anorectal motor responses to rectal distention. The rectal compliance in children with severe brain damage was similar to the asymptomatic controls, whereas children with functional fecal retention had increased rectal compliance.

CONCLUSIONS

This study shows that colonic transit abnormalities in both the left colon and rectum may be responsible for constipation in children with severe brain damage.