Intestinal transit time in children with intestinal neuronal malformationsmimicking Hirschsprung's disease

A total of 106 consecutive children with intestinal neuronal malformations were included in a prospective study. The intestinal transit time was asses sed using a modification of Hinton's method. The results of transit time st udies, the associated specific histochemical findings, therapeutic procedur es, and the clinical course on follow-up assessments over a mean period of 2.4 years were analysed. The intestinal transit time was prolonged in all 5 3 patients with aganglionosis and in 37 (69.8%) out of 53 children with oth er intestinal malformations. Eight out of 16 children with IND type B had a n abnormal transit time, 1 underwent anterior resection, and 2 had a tempor ary colostomy. In 7 out of 8 children with hypoganglionosis and 9 out of 10 children with a reduced parasympathetic tone the transit time was prolonge d. A resection was performed in 7 and 2 of these children respectively. Bot h patients with heterotopia of the myenteric plexus had a prolonged bowel t ransit and parts of the large bowel had to be resected. Only 11 out of 17 c hildren with heterotopia of the submucous plexus, dysganglionosis, or immat ure ganglia had a prolonged transit time, 2 underwent sphincteromyotomy. At follow-up, all patients with malformations other than aganglionosis stated that symptoms had improved and they were willing to tolerate their complai nts. However, 25 reported on persistent constipation, 6 on overflow encopre sis. All children who required surgery had a prolonged intestinal transit time, but also 21 (56.8 %) of 37 children who were successfully treated without s urgery. None of the 16 children with normal transit had to be operated. It is concluded that specific histochemical findings do not always correlate w ith delayed intestinal transport. The determination of the intestinal trans it time represents an important tool to identify the clinical relevance of histochemical findings in the individual patient.