ABSTRACT: To describe the endosonographic anatomy of anal sphincters in healthy children and to evaluate the reproducibility of sphincter thickness measurements.
Forty-five healthy children with median age of 3.6 years (range, 1.0-14.5 years) were studied while under general anesthesia for minor surgery. Anal endosonography was performed with a 7- to 10-MHz rotating transducer with a diameter of 19 mm. The internal anal sphincter (IAS) and the external anal sphincter (EAS) were assessed by 2 independent observers.
IAS and EAS were identified in all children. The mean thickness of IAS and EAS were 1.3 mm and 5.3 mm, respectively. Identification of the inner and outer border of IAS was difficult, especially in children younger than 3 years. The thickness of EAS was easier to assess, and the interrater reliability for EAS thickness measurements was excellent. EAS thickness was positively correlated with the children's age. Reflectivity varied within the EAS with frequent hyporeflective areas.
Anal endosonography provided visualization of the IAS and EAS in children. Assessment of exact IAS thickness was difficult, especially in the youngest children. Mean EAS thickness was 5.3 mm, increasing with age. Hyporeflective areas of the intact EAS should not be misinterpreted as sphincter defects.
Journal of Pediatric Surgery 08/2011; 46(8):1587-92. · 1.45 Impact Factor
ABSTRACT: Hirschsprung's disease (HD) may be associated with inflammation in the colon. Further, the etiology of Hirschsprung-associated enterocolitis (HEC) is unclear. To learn more about these features, we examined our cohort of HD patients during a period of 6 years for inflammation in their colonic mucosa as well as for signs of HEC.
Rectal suction biopsies and operative full thickness aganglionic and ganglionic colonic specimens from 36 patients were examined. Signs of inflammation were recorded in hematoxylin/eosin/saffron (HES)-stained sections and with fluorescence conjugated polyclonal antibodies to IgA and IgG applied on serial sections. The suction biopsies were also evaluated for the presence of mucus inspissation and crypt dilatation. Clinical signs of HEC were recorded from medical files of the same 36 patients.
HES-staining revealed that seven patients had inflammation in the suction biopsies; these patients were significantly older than the patients without inflammation. Slight mucus inspissation was identified in suction biopsies of five out of 33 patients, but crypt abscesses or ulcerations were not found in any specimens. Virtually all very young patients (<3 months) had slight crypt dilatation. We identified inflammation in resected colonic segments from 17 out of 36 patients. Thirteen of these 17 had a diverting colostomy, and only one out of 14 patients with colostomy had no inflammation. Inflammatory changes were similar in ganglionic and aganglionic bowel. By immunofluorescence (IF) staining, inflammation was found in resected colonic segments from five patients. Four of these had a colostomy. HEC was diagnosed in three patients, and inflammation detected in resected specimens from only one of these three.
We have not been able to identify particular characteristics in the colonic or rectal mucosa that are linked to development of HEC. Inflammation in the resected specimen was mainly found in patients with a diverting colostomy, and then in both ganglionic and aganglionic colon.
Pediatric Surgery International 12/2008; 25(2):133-8. · 1.25 Impact Factor
ABSTRACT: Traditional surgical management of Hirschsprung's disease consists of a three-stage approach including proximal colostomy, definitive pull-through resection at one year of age and closure of the stoma shortly after the pull-through. At our institution, patients with this disorder have been operated with a one-stage transanal technique without laparotomy and colostomy since 2001. The early results of this procedure are presented in the article.
Complications and postoperative bowel function have been recorded after the introduction of the one-stage transanal technique.
Transanal pull-through was intended in 20 children. Laparotomy (5 patients) and laparoscopy (1 patient) were done in 6 of the children due to technical reasons. Median weight at operation was five kg (3.5-25 kg), and a median of 25 cm of bowel (9-36 cm) were resected transanally. There were no perioperative complications. Postoperative complications included stricture (3 patients), perianal excoriations (2 patients) and severe constipation (1 patient). Short term follow up shows similar bowel habits as after laparotomy procedures.
Early results show that primary transanal pull-through in Hirschsprung's disease patients with aganglionosis to descending colon is safe. It is beneficial to avoid a colostomy and probably laparotomy.
Tidsskrift for den Norske laegeforening 10/2005; 125(17):2358-9.