Cases till now for ANMS Explained by Dr. Arun Aggarwal Gastroenterologist

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Dr. Arun Aggarwal Gastroenterologist
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CASE I

• 7 year old male with h/o chronic constipation and
  encopresis
• Never had formed stools in life, always leaking
• On regular diet
• No organic cause of constipation

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• Physical examination normal
• Rectal full of stools
• Multiple admissions in past for clean out.

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Previous Investigations

• CBC, BMP normal
• Abdominal X ray fecal loading
• Barium enema no transition zone, reduntant colon
• Anorectal manometry average resting pressure
  69-86, RAIR present at 30 cc, max squeeze
  pressure at 116/9 mmHg
• Rectal biopsy ganglion cells present
• Colonic transit study slow transit

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Previous medicines

• Enemas
• Suppositories
• Miralax
• Stimulant laxatives
• Golytely

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Referred from outside hospital for further
evaluation before possible colectomy..
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• Plan was made for colonic manometry
• Colonic catheter placed with colonoscopy
• Colonoscopy dilated colon

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Baseline colonic manometry showed good activity
in colon
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Increase in colonic activity after meals
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Colonic manometry after Bisacodyl administration
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Colonic manometry after Bisacodyl administration
showing High Amplitude propagated contractions
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Colonic manometry after Bisacodyl administration
showing High Amplitude propagated contractions
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• RESULT normal colonic manometry
• PLAN cecostomy for antegrade enemas avoid
  colectomy.

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CASE II

• 7 year old male with chronic constipation and
  encopresis.
• No other significant past medical history.
• No organic cause of constipation.
• Physical examination normal

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• CBC, BMP, Ca, TFT, celiac profile normal
• Anorectal manometry and suction biopsy normal
• MRI normal lumbosacral spine, constipation
• Barium enema normal

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• Previous medications
• Miralax
• Exlax
• Enemas
• Suppositories
• Clean out in the ER

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• colonic manometry followed by cecostomy was done
  in 10/09.
• Started on antegrade enemas.
• Continued to have stool retention and encopresis

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Admitted for repeated colonic manometry to decide
for further management..
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Baseline colonic manometry
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Motility with meal
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Motility after bisacodyl
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Colonic manometry showing HAPC in proximal
colon, none in distal colon
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Colonic manometry showing HAPC in proximal
colon, none in distal colon
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• RESULT normal proximal colonic manometry, no
  motility in distal colon.
• PLAN distal colectomy.