COLONIC TRANSIT AND ANORECTAL MANOMETRY IN CHILDREN WITH SEVERE BRAIN-DAMAGE

Objective, This study was conceived to determine the physiologic abnor malities in distal gastrointestinal motility that are responsible for constipation in brain-damaged children. Design. Colonic transit and an orectal manometry were evaluated in 16 children with severe brain dama ge and constipation (mean age +/- SD; 5.1 +/- 3.5 years) and the resul ts were compared with findings in 15 age- and sex-matched children wit h functional fecal retention and normal mental development. Anorectal motility findings also were compared with those from 11 asymptomatic c hildren. The progress of radiopaque markers, as determined by sequenti al plain abdominal radiographs, was used to evaluate segmental colonic transit times. Results. In children with brain damage, colonic transi t was prolonged at the level of left colon in 18.8% of the patients, a t both left colon and rectum in 56.2%, and at rectum only in 25%. Thes e findings differed (P <.05) from those in children with functional fe cal retention wherein transit was prolonged in the left colon and rect um in 20% of the patients and the rectum only in 80%. By anorectal man ometry, no significant intergroup differences were detected in anal pr essures 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 ret ention had increased rectal compliance. Conclusions. This study shows that colonic transit abnormalities in both the left colon and rectum m ay be responsible for constipation in children with severe brain damag e.