ACCURACY OF ANORECTAL MANOMETRY IN THE DIAGNOSIS OF HIRSCHSPRUNGS DISEASE IN CHILDREN.

Aim: Accuracy of Anorectal Manometry in the Diagnosis of Hirschsprung?s Disease in Children Materials and Methods: This was a case control study conducted in the Department of Paediatric Surgery, Sher-I-Kashmir Institute of Medical Sciences from December 99 to June 2002.Control subjects consisted of 50 children whose ages ranged from 1 day to 13 years. None of the controls had any history of defecation disorder. All the controls had rectoanal inhibitory reflex present at the time of examination. The patient group consisted of 50 children with constipation. Results: All the controls had rectoanal inhibitory reflex present at the time of examination. Resting rectal pressures recorded in them ranged from 5-11cmH,0 and the Mean anal canal pressure ranged from 14-54 cm H2O.Functional anal canal length ranged from 1.0-3.5cms.In our series 50 % of patients were diagnosed to be suffering from Hirschsprung\'s disease and 33.3 % were diagnosed to be suffering from idiopathic constipation. Youngest patient was 10 days old who presented with necrotizing enterocolitis of Hirschsprung\'s disease and the oldest presented as a case of neglected chronic constipation in intestinal obstruction. Anorectal pressure profile did not differ much between the control group and the patient group with average resting rectal pressure ranging from 4-14 cmH20 and mean anal canal pressure ranging from 10-48 cmH20.The length of the anal canal averaged 1.0-3.0 cms. There were 3 false negatives and 2 false positives for Hirschsprung\'s disease on anorectalmanometry with overall diagnostic accuracy of 83.3%. Conclusion: Anorectal Manometry is an accurate, noninvasive test which has a place as screening test of choice for Hirschsprung?s disease.