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[Idiopathic constipation in children: 10-year experience]
M Messina1, D Meucci, G Di Maggio
1Cattedra di Chirurgia Pediatrica, Università degli Studi di Siena, Italia.
Insights
Accurate diagnosis of pediatric constipation using anorectal manometry and colonic transit time evaluation is crucial. This approach effectively categorizes constipation types, enabling tailored treatments and improving patient outcomes.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Diagnostic Imaging
Context:
- Constipation is a common pediatric issue often underestimated by parents and pediatricians.
- Delayed specialist consultation can lead to complications.
- A dedicated study center developed a diagnostic and therapeutic protocol for pediatric constipation.
Purpose:
- To report the experience of a pediatric surgery department in diagnosing and treating chronic constipation in children.
- To evaluate the effectiveness of a diagnostic protocol involving scintigraphic colonic transit time and anorectal manometry.
- To correlate diagnostic findings with specific constipation types and subsequent treatment strategies.
Summary:
- A study evaluated 174 children with chronic constipation using scintigraphic colonic transit time and anorectal manometry.
- These diagnostic tools differentiated patients into colonic and rectal constipation groups.
- Initial management included dietetic, behavioral, and pharmacological treatments, followed by specific therapies like biofeedback or surgery based on diagnosis.
Impact:
- The diagnostic protocol successfully classified constipation types, guiding appropriate therapeutic interventions.
- Recovery or improvement was observed in 83.53% of cases.
- Anorectal manometry and colonic transit time evaluation are emphasized as key diagnostic methods for effective pediatric constipation management.
Abstract:
Constipation is a frequent clinical disorder in pediatric age and it is often difficult to resolve without a suitable diagnostic and therapeutic approach. Parents and pediatrician often underestimate this pathology, reaching the specialist only when it has already shown its complications. In the Department of Pediatric Surgery of Siena, in the last 10 years, we have activated a study centre on constipation in the pediatric age and we have developed a diagnostic and therapeutic protocol to give indications on the type of constipation and the consequent therapy. The Authors report their experience on 174 children with chronic constipation. The patients underwent a scintigraphic colonic transit time evaluation by radionuclides, an enema and an anorectal manometry. Such examinations were able to divide patients into two groups: with colonic and rectal constipation. The management consisted in common dietetic, behavioural and pharmacological treatment at first and then of specific treatment (biofeedback, prokinetic, emicolectomy), according to the type. The follow up showed recovery or improvement in 83.53% cases, unchanged clinical condition in 8.57%, aggravation in 1.9%. The Authors conclude emphasising the importance of diagnostic techniques that allow to frame correctly the pediatric patient affected by constipation. Particularly the anorectal manometry can be considered a first level examination, able to identify rectal constipation; together with scintigraphic colonic transit time that individualizes colonic constipation. The right diagnosis will be able to give a suitable therapeutic treatment.