Effect of colon transection on spontaneous and meal-induced high-amplitude--propagating contractions in children.

Background: After Hirschsprung disease (HD) surgery, many children experience fecal incontinence caused by increased number of high-amplitude-propagating contractions (HAPCs) through the neorectum to the anal verge. The aim of this study was to determine whether children with HD have more HAPCs than children with colon transections for reasons other than HD.

Methods: We reviewed 500 colon manometries. Children (age 7.6 ± 5.1 years, 275 boys) with functional constipation (n = 237, age 7.4 ± 5.0 years, 126 boys) and chronic abdominal pain (n = 48, age 9.8 ± 5.8 years, 25 boys) served as controls compared with subjects with HD (n = 56, age 6.9 ± 4.1 years, 44 boys) and colon transection for other reasons (n = 24, age 6.1 ± 5.8 years, 12 boys). We excluded 139 subjects without HAPCs. We documented HAPCs during 1-hour fasting and 1-hour postprandial. Results are in mean ± SD.

Results: During fasting, HD subjects had more HAPCs (2.2 ± 3.4/hour) versus functional constipation (0.8 ± 2.2/hour, P = 0.0004) and chronic pain (0.5 ± 1.1/hour, P = 0.001), but not more than colon transection (1.9 ± 3.2/hour, P = 1.0). HD showed more postprandial HAPCs (4.0 ± 5.4/hour) than functional constipation (1.5 ± 2.5/hour, P < 0.0001) and chronic pain (0.9 ± 1.6/hour, P < 0.0001), but not more than colon transection (2.4 ± 3.0/hour, P = 0.6). There were more HAPCs fasting and postprandial after colon transection (1.9 ± 3.2/hour and 2.4 ± 3.0/hour) than functional constipation (0.8 ± 2.2/hour, P = 0.3 and 1.5 ± 2.5/hour, P = 1.0) and chronic pain (0.5 ± 1.1/hour, P = 1.0 and 0.9 ± 1.6, P = 1.0). HD subjects were divided by chief complaint: fecal incontinence or constipation. HD subjects with incontinence (n = 23) only had more HAPCs fasting (P = 0.01) and postprandial (P = 0.01) than HD subjects with constipation (n = 28) only.

Conclusions: Increased HAPCs followed colon transection, regardless of a cause. HD subjects with incontinence had more HAPCs than subjects with colon transection for other reasons.