[Radiology in chronic constipation in childhood].

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.