1 / 24

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

Dr. Arun Aggarwal is one of the famous doctor of Gastroenterology has studied some cases of ANMS and prepared report so that every one could realise there health problem or can get the review about that <br>

DrArunAggarwalGastroenterologist
Download Presentation

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

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Dr. ArunAggarwal Gastroenterologist

  2. 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

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

  4. 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

  5. Previous medicines Enemas Suppositories Miralax Stimulant laxatives Golytely

  6. Referred from outside hospital for further evaluation before possible colectomy…..

  7. Plan was made for colonic manometry Colonic catheter placed with colonoscopy Colonoscopy: dilated colon

  8. Baseline colonic manometry showed good activity in colon

  9. Increase in colonic activity after meals

  10. Colonic manometry after Bisacodyl administration

  11. Colonic manometry after Bisacodyl administration showing High Amplitude propagated contractions

  12. Colonic manometry after Bisacodyl administration showing High Amplitude propagated contractions

  13. RESULT: normal colonic manometry PLAN: cecostomy for antegrade enemas; avoid colectomy.

  14. 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

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

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

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

  18. Admitted for repeated colonic manometry to decide for further management…..

  19. Baseline colonic manometry

  20. Motility with meal

  21. Motility after bisacodyl

  22. Colonic manometry showing HAPC in proximal colon, none in distal colon

  23. Colonic manometry showing HAPC in proximal colon, none in distal colon

  24. RESULT: normal proximal colonic manometry, no motility in distal colon. PLAN: distal colectomy.

More Related