Stanton, Michael; (2005) Colonic dysmotility in children. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

The literature review of this thesis describes the development, structure and function of the enteric nervous system and the known congenital anomalies, which can cause colonic dysmotility. The clinical investigations used to assess children with idiopathic chronic constipation are outlined, together with the medical and surgical therapies used in the treatment of this condition. Four studies are reported, the first of which is a retrospective review of 101 scintigraphic studies of colonic transit in the investigation of children with idiopathic chronic constipation. Second, an in vitro study of neuromuscular transmission in colonic circular muscle from adults (with carcinoma) and children with slow colonic transit (defined on radio-isotope study) is described. Third, a retrospective review of the clinical outcome of 11 children with severe slow-transit constipation in whom laparoscopic formation of an appendicostomy for colonic washouts has been carried out is reported. The fourth study is series of 7 children in whom per-appendicostomy insertion of a catheter and subsequent 24-hour studies of multipoint colonic manometry was undertaken. The results of these studies are then discussed to explain the possible implications in relation to the knowledge of the aetiology, clinical investigation and management of children with colonic dysmotility. The overall hypothesis of this thesis is that children with idiopathic chronic constipation have identifiable physiological abnormalities in colonic motor function, which may be due to enteric neuronal abnormalities.

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