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The plain abdominal roentgenogram in the management of encopresis
R M Rockney1, W H McQuade, A L Days
1Department of Pediatrics, Brown University, Memorial Hospital, Pawtucket, RI 02860, USA.
Insights
Plain abdominal roentgenograms objectively assess fecal retention in encopretic children. While most encopretic children show fecal retention, a negative rectal exam may require a roentgenogram for diagnosis.
Area of Science:
- Pediatric Gastroenterology
- Diagnostic Imaging
Background:
- Encopresis is a common childhood condition often associated with fecal retention.
- Objective assessment of fecal retention is crucial for diagnosis and management.
Purpose of the Study:
- To evaluate the utility of plain abdominal roentgenograms in objectively assessing fecal retention in encopretic children.
- To determine the association between radiographic evidence of fecal retention and clinical findings.
Main Methods:
- Retrospective case study design.
- Inclusion of 60 encopretic children (aged 4-18 years) from pediatric incontinence clinics.
- All participants underwent a plain abdominal roentgenogram upon presentation.
Main Results:
- Plain abdominal roentgenograms identified fecal retention in 78% of encopretic children.
- Retentive encopretic children were less likely to have difficult toilet training history (P=.018) but more likely to have excessive stool on rectal exam (P=.015).
- Rectal examination had a positive predictive value of 84.8% for fecal retention, while a negative exam had a 50% negative predictive value.
Conclusions:
- Plain abdominal roentgenograms provide an objective method for assessing fecal retention in encopretic children.
- Most encopretic children present with fecal retention, but not all.
- A positive rectal examination is highly predictive of fecal retention, negating the need for roentgenography; however, a negative rectal exam may warrant a roentgenogram.
Objective:
To determine whether fecal retention in encopretic children can be assessed objectively using the plain abdominal roentgenogram and whether roentgenographic evidence of fecal retention is associated with clinical findings on presentation in encopretic children.
Design:
Retrospective case studies.
Setting:
Two pediatric incontinence clinics.
Participants:
Sixty children (72% male), aged 4 to 18 years (mean, 8 years), who met Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition criteria for the diagnosis of encopresis. All had a plain abdominal roentgenogram obtained on presentation.
Interventions:
None.
Results:
Using a systematic assessment tool with good interrater reliability (kappa = 0.65), 78% (47) of the children had fecal retention by roentgenographic criteria on presentation, while 22% (13) did not. Retentive encopretic children were less likely to have a history of difficult toilet training (P = .018) than nonretentive encopretic children. There was no association between fecal retention and several clinical factors, including historical features commonly attributed to fecal retention. Retentive encopretic children were no more likely to have a palpable abdominal mass than nonretentive encopretic children, but they were more likely to have excessive stool on rectal examination (P = .015). Using the plain abdominal roentgenogram as the gold standard, the rectal examination showed a positive predictive value of 84.8% and a negative predictive value of 50% in assessing fecal retention.
Conclusions:
Fecal retention in encopretic children can be assessed objectively from a plain abdominal roentgenogram. Most, but not all, encopretic children present with fecal retention. A positive rectal examination is strongly predictive of fecal retention, in which case a roentgenogram is not necessary to make that diagnosis. A negative rectal examination may not rule out fecal retention, in which case an abdominal roentgenogram may be useful to make that diagnosis.