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[Chronic constipation in children]
1Divisione di Chirurgia Pediatrica, Ospedale Regionale di Vicenza, Italia.
Insights
Anorectal manometry effectively diagnoses Hirschsprung's disease in children. This diagnostic tool helps differentiate functional constipation from aganglionic conditions, guiding appropriate medical or surgical treatment for better outcomes.
Area of Science:
- Pediatric Gastroenterology
- Colorectal Surgery
Background:
- Chronic constipation in children can indicate various underlying conditions, including functional constipation and aganglionic diseases.
- Differentiating these causes is crucial for effective treatment and management.
Purpose of the Study:
- To evaluate the diagnostic utility of anorectal manometry in childhood constipation.
- To differentiate functional constipation from ultrashort segment Hirschsprung's disease.
Main Methods:
- Detailed patient history and physical examination.
- Anorectal manometry to assess the rectoanal inhibitory reflex.
- Analysis of diagnostic accuracy in children over two years of age.
Main Results:
- Anorectal manometry accurately diagnoses ultrashort segment Hirschsprung's disease.
- The rectoanal inhibitory reflex is present in functional constipation but absent in aganglionic conditions.
- The diagnostic error rate for anorectal manometry is very low in children over two years old.
Conclusions:
- Anorectal manometry is a safe and effective diagnostic tool for childhood constipation.
- Surgical intervention is recommended for ultrashort segment Hirschsprung's disease.
- Medical management is indicated for functional constipation and post-surgery, requiring adequate treatment duration to prevent relapses.
Abstract:
Chronic constipation in childhood, with or without megarectum, with or without encopresis is a symptom of many diseases. In the majority of this patients a detailed history and an accurate physical examination differentiate functional and aganglionic constipations by other causes of constipations. Anorectal manometry is an excellent diagnostic technique for diagnosis of ultrashort segment Hirschsprung's disease. The rectoanal inhibitory reflex is present in severe chronic functional constipations and absent in aganglionic constipations. Anorectal manometry is a simple and perfectly harmless technique. The possibility of error is very small in patients aged over two years. Surgical treatment is recommended in ultrashort segment Hirschsprung's disease. Medical treatment is recommended in chronic functional constipation and after surgical treatment. It is very important that the period of treatment is long enough to avoid relapses.