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[Chronic constipation in childhood. A report of 78 patients]
Samir Boukthir1, Afef Slimi, Sonia Mazigh
1Service de Médecine Infantile C, Hôpital d'Enfants de Tunis, Tunisie.
Insights
Functional constipation is the most common cause of chronic constipation in children. Hirschsprung's disease is the leading organic cause, highlighting the importance of rectal manometry for diagnosis.
Area of Science:
- Pediatric Gastroenterology
- Clinical Research
- Diagnostic Methods
Context:
- Chronic constipation is a common pediatric issue with diverse etiologies.
- Understanding the underlying causes is crucial for effective management.
- This study investigates the causes and clinical presentations of chronic constipation in children.
Purpose:
- To determine the etiological factors and clinical patterns of chronic constipation in pediatric patients.
- To evaluate the diagnostic utility of rectal manometry and biopsy in identifying organic causes.
- To assess treatment outcomes for different types of constipation.
Summary:
- A retrospective study of 78 children with chronic constipation found functional constipation in 62.8% and Hirschsprung's disease in 24.3%.
- Rectal manometry confirmed absent rectoanal reflex in 17 suspected Hirschsprung's cases, and biopsy revealed absent ganglion cells in 11.
- Treatments included laxatives, enemas, dietary changes, biofeedback for functional constipation, and surgical procedures for Hirschsprung's disease, with varying success rates.
Impact:
- Identifies functional constipation as the primary cause and Hirschsprung's disease as the main organic cause of chronic constipation in children.
- Emphasizes the critical role of rectal manometry in diagnosing Hirschsprung's disease.
- Provides insights into treatment strategies and outcomes for pediatric chronic constipation.
Aim:
To assess the aetiology and the clinical patterns of chronic constipation in children.
Methods:
A total of 78 patients (62% boys, mean age: 4.6 years) were enrolled in this retrospective study. For each patient, we collected these data: clinical features, radiological data, rectal manometry and rectal biopsy results, treatment and follow up.
Results:
Functional constipation was the most frequent cause of chronic constipation (49 cases, 62.8%) followed by Hirschsprung's disease (19 cases, 24.3%). Rectal manometry, performed in all suspected Hirschsprung's disease, concluded to the absence of inhibitory rectoanal reflex in 17 of them. Rectal biopsy concluded to segmental absence of parasympathetic ganglion cells in eleven of them. Therapeutic approach consists of treatment of functional constipation by laxatives, enemas and dietary fibers in respectively 22, 12 and 6 children. Two other patients had a biofeedback re-education. Treatment was successful in 9 patients and unsuccessful in 2 others. Seven children with Hirschsprung's disease underwent Soave's (n = 3), Swenson's (n = 3) and Duhamel's procedures (n = 1). Outcome was favourable in five of them and complicated by stenosis in 2 others.
Conclusion:
Our study suggests that functional constipation is the most frequent cause of chronic constipation in children and that Hirschsprung's disease is the first organic cause of chronic constipation indicating the need of rectal manometry for diagnostic confirmation.
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