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Topical application of isosorbide dinitrate in patients with persistent constipation after pull-through surgery for Hirschsprung's disease.
Eur J Pediatr Surg. 2007 Feb; 17(1):62-5.EJ

Abstract

AIMS

The aim of this study was to evaluate the anal manometric changes and the clinical effects after topical application of isosorbide dinitrate (ISDN) in patients with persistent constipation after pull-through surgery for Hirschsprung's disease (HD).

METHODS

We studied 3 children (2 males and 1 female), aged 2, 3 and 5 years respectively, who had undergone the Soave-Boley surgical procedure for HD and who suffered from persistent constipation after operation. We performed a pre- and postoperative anorectal manometry study and we applied ISDN paste (1 mg/kg two times daily) in the anal region for three weeks. All patients were followed-up and re-evaluated at 1, 3, and 6 months.

RESULTS

All patients showed an improvement of symptoms, with an average of 4 spontaneous evacuations per week. Prior to the topical treatment, the medium pressure was 115.6 mmHg (range 102 - 130 mmHg), the maximum pressure was 160 mmHg (range 145 - 175 mmHg), and the medium length of the high pressure zone was 1.8 cm (range 1.5 - 2.0 cm). At the 6 month follow-up, the medium pressure was 57.3 mmHg (range 52 - 61 mmHg, a decrease of 54.4 %), the maximum pressure was 98 mmHg (range 88 - 107 mmHg; a decrease of 38.7 %), and the medium length of the high pressure zone was 1.6 cm (range 1.4 - 1.8 cm; a decrease of 11.1 %).

CONCLUSIONS

Topical treatment with ISDN is a valid therapeutic alternative to an anal myotomy in patients with persistent constipation after pull-through surgery for HD. However, a greater number of cases and a longer follow-up are necessary to confirm the validity of our experience.

Authors+Show Affiliations

Section of Pediatric Surgery, Department of Pediatrics, Obstetrics and Reproductive Medicine, University of Siena, Siena, Italy. messinam@unisi.itNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

17407025

Citation

Messina, M, et al. "Topical Application of Isosorbide Dinitrate in Patients With Persistent Constipation After Pull-through Surgery for Hirschsprung's Disease." European Journal of Pediatric Surgery : Official Journal of Austrian Association of Pediatric Surgery ... [et Al] = Zeitschrift Fur Kinderchirurgie, vol. 17, no. 1, 2007, pp. 62-5.
Messina M, Amato G, Meucci D, et al. Topical application of isosorbide dinitrate in patients with persistent constipation after pull-through surgery for Hirschsprung's disease. Eur J Pediatr Surg. 2007;17(1):62-5.
Messina, M., Amato, G., Meucci, D., Molinaro, F., & Nardi, N. (2007). Topical application of isosorbide dinitrate in patients with persistent constipation after pull-through surgery for Hirschsprung's disease. European Journal of Pediatric Surgery : Official Journal of Austrian Association of Pediatric Surgery ... [et Al] = Zeitschrift Fur Kinderchirurgie, 17(1), 62-5.
Messina M, et al. Topical Application of Isosorbide Dinitrate in Patients With Persistent Constipation After Pull-through Surgery for Hirschsprung's Disease. Eur J Pediatr Surg. 2007;17(1):62-5. PubMed PMID: 17407025.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Topical application of isosorbide dinitrate in patients with persistent constipation after pull-through surgery for Hirschsprung's disease. AU - Messina,M, AU - Amato,G, AU - Meucci,D, AU - Molinaro,F, AU - Nardi,N, PY - 2007/4/5/pubmed PY - 2007/9/28/medline PY - 2007/4/5/entrez SP - 62 EP - 5 JF - European journal of pediatric surgery : official journal of Austrian Association of Pediatric Surgery ... [et al] = Zeitschrift fur Kinderchirurgie JO - Eur J Pediatr Surg VL - 17 IS - 1 N2 - AIMS: The aim of this study was to evaluate the anal manometric changes and the clinical effects after topical application of isosorbide dinitrate (ISDN) in patients with persistent constipation after pull-through surgery for Hirschsprung's disease (HD). METHODS: We studied 3 children (2 males and 1 female), aged 2, 3 and 5 years respectively, who had undergone the Soave-Boley surgical procedure for HD and who suffered from persistent constipation after operation. We performed a pre- and postoperative anorectal manometry study and we applied ISDN paste (1 mg/kg two times daily) in the anal region for three weeks. All patients were followed-up and re-evaluated at 1, 3, and 6 months. RESULTS: All patients showed an improvement of symptoms, with an average of 4 spontaneous evacuations per week. Prior to the topical treatment, the medium pressure was 115.6 mmHg (range 102 - 130 mmHg), the maximum pressure was 160 mmHg (range 145 - 175 mmHg), and the medium length of the high pressure zone was 1.8 cm (range 1.5 - 2.0 cm). At the 6 month follow-up, the medium pressure was 57.3 mmHg (range 52 - 61 mmHg, a decrease of 54.4 %), the maximum pressure was 98 mmHg (range 88 - 107 mmHg; a decrease of 38.7 %), and the medium length of the high pressure zone was 1.6 cm (range 1.4 - 1.8 cm; a decrease of 11.1 %). CONCLUSIONS: Topical treatment with ISDN is a valid therapeutic alternative to an anal myotomy in patients with persistent constipation after pull-through surgery for HD. However, a greater number of cases and a longer follow-up are necessary to confirm the validity of our experience. SN - 0939-7248 UR - https://www.unboundmedicine.com/medline/citation/17407025/Topical_application_of_isosorbide_dinitrate_in_patients_with_persistent_constipation_after_pull_through_surgery_for_Hirschsprung's_disease_ L2 - http://www.thieme-connect.com/DOI/DOI?10.1055/s-2007-964885 DB - PRIME DP - Unbound Medicine ER -