Anorectal manometry on children: A moroccan series and literature review

Abstract

BACKGROUND: Anorectal manometry (ARM) is a test used to evaluate the rectum and anus functions. It also helps to diagnose several conditions such as fecal incontinence and constipation. This test is being increasingly performed on children of all ages. AIM: The aim of our study is to determine the benefit of ARM on children and to report our experience.. METHODS: Over a period of 4 years, data and test results of 273 children were analyzed. RESULTS: Out of 273 patients (68.5% boys and 31.5% girls with a mean age of 9 years), 154 patients (51.6%) had fecal incontinence (Group 1), 75 children (27.5%) had chronic constipation (CC) (Group 2), and 37 children (13.6%) had both of them (Group 3). An awake manometry was performed on 248 children (91%); however, under sedation, the test allowed us the exclusion of Hirschsprung’s disease (HD) in 21 children (84%). Bad anal contraction was present in 25% of patients in group 1 and 21.6% of patients in group 3. The statistical analysis showed a significant difference in age (p = 0.022) and resting pressure (p = 0.050) between the three groups. Children with fecal incontinence had a higher rate of dyssynergy, 80.2% and 83.8%, in groups 1 and 3, respectively, compared to 60.4% in patients with CC (p = 0.852). CONCLUSION: ARM is the gold standard for terminal constipation and encopresis exploration on children. In our study, this test was efficient for the exclusion of HD in infants suffering from constipation, in the other hand, we found a high rate of dyssynergy on children with fecal incontinence (80%) and a biofeedback therapy was proposed in this case.