Chronic constipation. Manometric patterns and surgical considerations.
We studied 80 children who had severe chronic constipation that was refractory to dietary, medicinal, and psychiatric therapy by means of barium enemas, rectal biopsies, and manometry. Four patients had Hirschsprung's disease and three patients had segmental dilatation of the colon. The remaining 73 patients had radiologically dilated anorectums with inpaction. Only 49 patients underwent rectal wall biopsies. All of the specimens were positive for ganglion cells. Manometric study of the 73 patients showed 18 patients who had elevated internal sphincter pressures with good relaxation following balloon inflation (group A); 45 patients who had normal internal sphincter pressures but no relaxation following balloon inflation (similar to Hirschsprung's disease) (group B); and ten patients who had normal pressures with good relaxation. Twenty-five patients in groups A and B had internal sphincter myectomies. Eight patients resumed normal bowel movements, 11 patients required minimal medicinal help, and two patients' conditions did not improve. Postoperatively, there was a reduction to normal pressure levels in group A patients and relaxation of the internal sphincter in group B patients.