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Hiromichi Ikawa, MD; Samuel H. Kim, MD; W. Hardy Hendren, MD; Patricia K. Donahoe, MD

Arch Surg. 1986;121(4):435-438.

Abstract
• We studied 309 constipated infants and children who underwent rectal manometry (n=261) and/or punch rectal biopsy, in which acetylcholinesterase histochemistry (n=124) was compared with routine histologic examination (n=93) for diagnostic accuracy. A 99% diagnostic accuracy was achieved with acetylcholinesterase histochemistry compared with 61% accuracy with routine hematoxylin-eosin staining on punch rectal biopsy. We recommend screening cooperative, quiet patients with rectal manometry. Most patients with abnormal manometric studies or those on whom manometry cannot be performed should have superficial punch biopsy (exceptthose ill infants who require urgent operative intervention). This plan of management provides the least invasive but the most accurate evaluation of the constipated child. Deep rectal biopsy can be avoided except in the very rare child with hypoganglionosis or "skip-area" aganglionosis, which can be detected by manometry.

(Arch Surg 1986;121:435-438)

Author Affiliations
From the Division of Pediatric Surgery and the Pediatric Surgical Research Laboratories, Massachusetts General Hospital and Harvard Medical School, Boston.

Footnotes
Accepted for publication Jan 3, 1986.

Read before the 66th Annual Meeting of the New England Surgical Society, Dixville Notch, NH, Oct 12, 1985.

Reprint requests to Division of Pediatric Surgery, Massachusetts General Hospital, Boston, MA 02214 (Dr Donahoe).

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