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Assessing fecal load with ultrasound in children with colorectal pathology: ReKiSo study
Daniel Erkel1, Stefanie Märzheuser2, Judith Lindert2
1Department of Pediatric Surgery, University Hospital Rostock, Ernst-Heydemann-Straße 8, 18057, Rostock, Germany. daniel.erkel@uni-rostock.de.
Insights
Transabdominal rectal ultrasound (TRU) effectively measures rectal diameter to assess fecal load in children with colorectal conditions, aiding constipation diagnosis and bowel management monitoring without radiation.
Area of Science:
- Pediatric Gastroenterology
- Diagnostic Imaging
- Colorectal Surgery
Background:
- Bowel management (BM) in children with colorectal pathology requires effective monitoring tools.
- Assessing fecal load is crucial for diagnosing and managing conditions like Hirschsprung disease (HD), anorectal malformation (ARM), and functional constipation (FC).
- Current methods may have limitations, necessitating the exploration of non-invasive techniques.
Purpose of the Study:
- To evaluate transabdominal rectal ultrasound (TRU) for assessing fecal load in pediatric patients undergoing bowel management.
- To measure transverse rectal diameter (TRD) as an indicator of fecal impaction.
- To establish the utility of TRU in diagnosing constipation and monitoring BM efficacy.
Main Methods:
- A prospective case-control study involving children with HD, ARM, and FC receiving BM.
- Utilized the Klijn method to visualize TRD and assess fecal load via TRU.
- Compared TRD measurements with clinical outcomes and followed patients for 1-6 months.
Main Results:
- Transverse rectal diameter (TRD) measurements showed statistically significant differences across patient groups (p < 0.05).
- A TRD cut-off of 3 cm was identified as a potential discriminator between children with and without constipation/overload symptoms.
- Ultrasound proved effective in assessing fecal load and monitoring bowel management outcomes.
Conclusions:
- Transabdominal rectal ultrasound (TRU) is a valuable, radiation-free tool for assessing fecal load in children.
- TRU aids in the diagnosis of constipation and monitoring the effectiveness of bowel management.
- A 3 cm TRD threshold may help differentiate symptomatic from asymptomatic children, regardless of underlying colorectal pathology.
Purpose:
To evaluate bowel management for children with colorectal pathology by measuring transverse rectal diameter (TRD) and assessing fecal load with transabdominal rectal ultrasound (TRU).
Methods:
Prospective case-control study of children receiving bowel management (BM) between 04/2023 and 04/2024 was done. There was inclusion of patients with Hirschsprung disease (HD), anorectal malformation (ARM) and functional constipation (FC). Patients with other congenital or neurological conditions were excluded. Control group consisted of inpatients and outpatients without abdominal complaints. FC was diagnosed according to ROM-IV-criteria. For HD and ARM, we followed a list of symptoms. To assess fecal load, we visualized the TRD using the Klijn (Klijn et al. in J Urol 172:1986-1988, 2004) method. The bladder was moderately full. The fecal load was assessed retrograde from the rectum. Follow-up was at 1/3/6 months. Secondary data were collected from medical records. Sample size calculated a priori and follow-up group with new gathered data.
Results:
p value for TRD in all groups significant with p < 0.05 and in grouped follow-up.
Conclusion:
Ultrasound is a useful tool for assessing fecal load and helps diagnose constipation and monitor BM. Irrespective of colorectal pathology, a cut-off of 3 cm seems to discriminate between children without constipation/overload symptoms and asymptomatic patients. We present a radiation-free method for monitoring bowel management.
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