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Diagnosis and follow-up in constipated children: should we use ultrasound?

Ayşe Karaman1, Selma Uysal Ramadan, Ibrahim Karaman

  • 1Department of Pediatric Surgery, Dr Sami Ulus Children's Hospital, 06080 Ankara, Turkey. ayseuk@gmail.com

Journal of Pediatric Surgery
|September 21, 2010
PubMed

Insights

Ultrasound effectively identifies megarectum and fecal load in constipation, providing objective criteria for diagnosis and treatment follow-up. While rectal diameter improved post-treatment, it did not fully normalize.

Area of Science:

  • Pediatric Gastroenterology
  • Diagnostic Imaging
  • Medical Ultrasound

Background:

  • Constipation is a common pediatric issue often diagnosed subjectively.
  • Objective diagnostic criteria for megarectum and fecal impaction are needed.
  • Ultrasound (US) offers a non-invasive imaging modality for evaluating rectal parameters.

Purpose of the Study:

  • To assess the efficacy of pelvic ultrasonography in diagnosing megarectum and fecal load in constipated children.
  • To establish objective ultrasound criteria for constipation diagnosis.
  • To evaluate the response to treatment using ultrasound measurements.

Main Methods:

  • Sixty-six children were divided into constipated (n=35) and control (n=31) groups based on Rome III criteria.
  • Pelvic ultrasonography was performed by two radiologists to measure rectal diameter, anterior wall thickness, and assess fecal load.
  • Measurements were taken with both full and empty bladders and repeated after one month of treatment.

Main Results:

  • Ultrasound measurements showed high inter-observer reliability (r=0.981).
  • Constipated children exhibited significantly larger post-void rectal diameters (3.02 cm vs 1.98 cm) and increased fecal load.
  • A rectal diameter cutoff of 2.44 cm was identified as diagnostic for constipation (71% sensitivity, 76% specificity).
  • Treatment led to significant reductions in constipation scores and fecal load, but rectal diameter remained elevated.

Conclusions:

  • Ultrasound provides objective and reproducible criteria for diagnosing constipation, megarectum, and fecal load in children.
  • It aids in treatment follow-up and enhances patient/family understanding of treatment necessity.
  • Further evaluation is needed as rectal diameter may not normalize within one month of treatment.
Abstract

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