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Transabdominal ultrasound of rectum as a diagnostic tool in childhood constipation
Iben Moeller Joensson1, Charlotte Siggaard, Soren Rittig
1Clinical Institute, University of Aarhus, Aarhus, Denmark. iben.jonsson@ki.au.dk
Insights
Transverse rectal diameter measured by ultrasound can identify rectal impaction in children. Constipated children have larger rectal diameters, which significantly decrease with treatment.
Area of Science:
- Pediatric Gastroenterology
- Diagnostic Imaging
- Colorectal Health
Background:
- Chronic constipation is a common pediatric issue.
- Accurate diagnosis of rectal impaction is crucial for effective treatment.
- Current diagnostic methods may have limitations.
Purpose of the Study:
- To evaluate ultrasound-measured transverse rectal diameter for identifying rectal impaction in children.
- To compare rectal diameter in constipated versus healthy children.
- To assess changes in rectal diameter during constipation treatment.
Main Methods:
- Ultrasound measurement of transverse rectal diameter in 51 children (27 constipated, 24 healthy) aged 4-12 years.
- Inclusion of digital rectal examination and medical history.
- Repeat measurements after 4 weeks of laxative treatment for constipated children.
Main Results:
- A threshold of >29.4 mm for transverse rectal diameter indicated rectal impaction.
- Constipated children showed significantly larger rectal diameters (42.1 mm) than healthy children (21.4 mm).
- Treatment reduced rectal diameter significantly (to 26.9 mm) in constipated children.
Conclusions:
- Transverse rectal diameter via ultrasound is a valuable, potentially non-invasive tool for diagnosing rectal impaction in children.
- This method can differentiate constipated from healthy children.
- Treatment effectively reduces rectal diameter, correlating with improved constipation.
Purpose:
We tested whether transverse rectal diameter measured by ultrasound could identify rectal impaction, investigated whether transverse diameter is enlarged in constipated children compared to healthy children and evaluated transverse diameter during treatment of constipation.
Materials And Methods:
A total of 51 children 4 to 12 years old were included in the study. Of the children 27 (mean age 7.0 +/- 1.8 years) had been diagnosed with chronic constipation by Rome III criteria and 24 (9.1 +/- 2.7 years) were healthy controls. All patients underwent a thorough medical history and physical examination, including digital rectal examination and measurement of rectal diameter by transabdominal ultrasound. Constipated children underwent repeat investigations after 4 weeks of laxative treatment.
Results:
Average rectal diameter of children with negative digital rectal examination was 21 +/- 4.2 mm (mean +/- SD), leading to the approximation that a value greater than 29.4 mm (mean +/- 2 SD) indicates rectal impaction. All children with rectal impaction identified by digital examination had a rectal diameter larger than 29.4 mm. Moreover, constipated children had a significantly larger rectal diameter (42.1 +/- 15.4 mm) than healthy children (21.4 +/- 6.0 mm, p <0.001). After 4 weeks of laxative treatment constipated children had a significant reduction in rectal diameter (mean 26.9 +/- 5.6 mm, p <0.001).
Conclusions:
Transverse rectal diameter seems to be a valuable tool to identify rectal impaction and may replace digital rectal examination. Constipated children have a significantly larger rectal diameter compared to healthy children, and when constipation is treated the diameter is reduced significantly.
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