Related Experiment Videos
[Radiology in chronic constipation in childhood]
Insights
Diagnosing chronic constipation in children requires comprehensive evaluation. Total intestinal transit time (TITT) is crucial for diagnosis, while anorectal manometry (ARM) offers superior sensitivity over radiology for assessing constipation nature.
Area of Science:
- Pediatric Gastroenterology
- Colorectal Surgery
Background:
- Chronic constipation is a common pediatric referral issue.
- Accurate diagnosis is essential for effective management and to rule out serious conditions like Hirschsprung's disease.
Purpose of the Study:
- To evaluate the diagnostic utility of various investigations for chronic constipation in children.
- To compare the sensitivity of different diagnostic modalities.
Main Methods:
- A cohort of 113 children with chronic constipation underwent a diagnostic work-up.
- Investigations included anal inspection, rectal exploration, bowel frequency evaluation, intestinal transit times (TITT, SITT), contrast enema, anorectal manometry (ARM), and suction rectal biopsy.
Main Results:
- Functional constipation was diagnosed in 53 children, functional constipation with soiling in 32, and Hirschsprung's disease in 18.
- Total intestinal transit time (TITT) was key for diagnosis, while 10 children with normal TITT required no further examination.
- Anorectal manometry (ARM) demonstrated higher sensitivity than radiology in assessing constipation nature.
- Suction rectal biopsy proved reliable for detecting aganglionosis, with accuracy enhanced by histochemical/biochemical determination of Acetylcholinoesterase.
Conclusions:
- While bowel frequency indicates a gastrointestinal issue, TITT is definitive for diagnosing constipation.
- ARM is more sensitive than radiological methods for evaluating the nature of chronic constipation.
- Suction rectal biopsy is a reliable diagnostic tool for aganglionosis, especially when supplemented with specific biochemical assays.
Abstract:
One hundred thirteen children referred for chronic constipation were examined by means of diagnostic work-up including anal inspection, rectal exploration, weekly bowel frequency evaluation, measurement of total and segmental intestinal transit times (TITT, SITT), contrast enema, anorectal manometry (ARM), suction rectal biopsy for histochemistry. Final diagnosis were: chronic functional "simple" constipation in 53 children; chronic functional constipation and soiling in 32; Hirschsprung's disease in 18. In 10 children, initially referred for constipation, TITT was in the normal range so they underwent no further examination. Conclusions are that bowel frequency identifies a real gastrointestinal problem, but definite diagnosis of constipation is relied on TITT. In the assessment of chronic constipation nature, ARM is more sensitive than radiology. Suction rectal biopsy is reliable in detection of aganglionosis: its accuracy can be improved by histochemical or biochemical determination of Acetylcholinoesterase.