Abstract
Despite the definitive surgery using ganglionic segment in children with Hirschsprung's disease (HD), approximately 10%〜20% continue to experience vomiting, diarrhoea, abdominal disetension and severe feeding difficulties. These are suggestive of a motility disorder in the histologically innervated bowel of such children. We have performed antroduodenal manometry to investigate the fasting phase III and fed activities on seven patients with HD and age matched controls (C). Two children were with total colon aganglionosis (TCA), one with long segment aganglionosis and four with rectosigmoid aganglionosis (RSA). All of these children but one with RSA have various abdominal symptoms after the surgery. A three port catheter was placed with the most proximal port in the antrum. Data was analyzed visually and using a computerized analytical program to determine amplitude, frequency, duration, cycle length and direction of propagation. Phase III was shorter in TCA (3.0, 3.6 min.) than HD (5.3〜6.3 min.) or C (6.2 min.) and of lower amplitude (TCA (10, 13 mmHg), HD (23〜45 mmHg), C (16 mmHg)). Antroduodenal hypomotility in TCA was suggested. In a case with RSA direction of phase III propagation was variable and postprandieal activitiy pattern was abnormal. Those may be the causes of upper gastrointestinal dysfunction and poor tolerance of feeds in these children. Furthermore it was suggested that motor disorder of HD is not limited to the aganglionic bowel.
