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Rectal biopsy in the investigation of constipation
1Wessex Regional Centre for Paediatric Surgery, Southampton General Hospital, UK.
Insights
Rectal biopsies may be unnecessary for constipated children if symptoms begin after the neonatal period. This study found Hirschsprung's disease exclusively in infants with early-onset constipation, guiding diagnostic criteria.
Area of Science:
- Pediatric Gastroenterology
- Colorectal Surgery
Background:
- Constipation is a common pediatric issue.
- Rectal biopsies are used to diagnose conditions like Hirschsprung's disease.
- Unnecessary biopsies can be avoided with clear diagnostic criteria.
Purpose of the Study:
- To establish criteria for avoiding unnecessary rectal biopsies in pediatric constipation.
- To differentiate Hirschsprung's disease from other causes of constipation based on symptom onset.
Main Methods:
- Retrospective review of 186 rectal biopsies from 141 children.
- Comparison of symptom onset age with Hirschsprung's disease diagnosis.
Main Results:
- All 17 children diagnosed with Hirschsprung's disease exhibited symptom onset before 4 weeks of age.
- Delayed meconium passage ( > 48 hours) was present in 27 children, with 10 diagnosed with Hirschsprung's disease.
- Three children with Hirschsprung's disease were referred post-neonatally but had symptom onset within the first 4 weeks.
Conclusions:
- A rectal biopsy is likely unnecessary if constipation onset occurs after the neonatal period.
- Symptom onset age is a critical factor in determining the need for rectal biopsy in constipated children.
- This finding can help refine diagnostic protocols and reduce invasive procedures.
Aims:
To develop criteria to prevent unnecessary rectal biopsies in constipated children.
Methods:
A retrospective review of 186 rectal biopsies from 141 children, comparing the age at onset of symptoms with the diagnosis of Hirschsprung's disease.
Results:
All of the 17 children with Hirschsprung's disease had the onset of symptoms before the age of 4 weeks. Twenty seven children had delayed passage of meconium (more than 48 hours) of whom 10 had Hirschsprung's disease. Three children with Hirschsprung's disease were referred after the neonatal period (2 months, 11 months, and 3 years) but all had the onset of symptoms before 4 weeks of age.
Conclusion:
If the age at onset of constipation is after the neonatal period, a rectal biopsy is unnecessary.