Assessing colonic anatomy normal values based on air contrast enemas in children younger than 6 years

Abstract

BackgroundContrast enemas with barium or water-soluble contrast agents are sometimes performed in children with severe intractable constipation to identify anatomical abnormalities. However there are no clear definitions for normal colonic size or abnormalities such as colonic dilation or sigmoid redundancy in children.ObjectiveTo describe characteristics of colonic anatomy on air contrast enemas in children without constipation to provide normal values for colonic size ratios in children.Materials and methodsWe performed a retrospective chart review of children aged 0–5 years who had undergone air contrast enemas for intussusception. The primary outcome measures were the ratios of the diameters and lengths of predetermined colonic segments (lengths of rectosigmoid and descending colon; diameters of rectum, sigmoid, descending colon, transverse colon and ascending colon) in relation to the L2 vertebral body width.ResultsWe included 119 children (median age 2.0 years, range 0–5 years, 68% boys). Colonic segment length ratios did not change significantly with age, although the differences for the rectosigmoid/L2 ratio were borderline significant (P = 0.05). The ratios that involved the rectal and ascending colon diameters increased significantly with age, while diameter ratios involving the other colonic segments did not. Differences by gender and race were not significant.ConclusionThese data can be used for reference purposes in young children undergoing contrast studies of the colon.

Author’s reply to comment on article: Redundant colon and refractory constipation in children

“…Bolia and Kumar commented that we found no differences in the diameters of the segmental colon between patients with constipation and the "reference" group. Although contrary to the data reported in the literature, data emerged from the comparison between our patients and those taken as reference and reported in the literature [2]. We do not know if the reason is due to the fact that children < 6 years had experienced a pneumatic reduction of intussusception.…”

“…Why we conclude that a ratio (rectosigmoid length/L2) > 15 is clinically significant? We used a ratio to eliminate the age factor as much as possible and to compare it to the Koppen and Al values [2]. We have identified a value of ratio > 15 because, in all our cases of refractory constipation, the values were greater than 15.…”

Segmental colonic dilation is associated with premature termination of high‐amplitude propagating contractions in children with intractable functional constipation

“…Regarding the different colonic segments, we compared colonic diameter and length, shown as SCS ratios, with data from a normative pediatric population of children <6 years of age (Table 4, original data are provided in the Data S1). 21 The SCS ratios for the length of the rectosigmoid and the descending colon were significantly larger in children with FC compared to the normative population (P<.0001 for both). In the sigmoid colon, the SCS ratio for colonic diameter was significantly larger in children with FC (P<.0007), but there was no significant difference between the SCS for the diameter of the rectum and the descending colon between the two groups.…”

“…Moreover, this technique does not require calibration with an external tool. This method has been described in another recent publication by our group, where we determined normative colon size characteristics in 119 children <6 years of age who underwent pneumatic reduction of intussusceptions . The data from this publication were used to compare the data from our current study with a normative population.…”

“…This method has been described in another recent publication by our group, where we determined normative colon size characteristics in 119 children <6 years of age who underwent pneumatic reduction of intussusceptions. 21 The F I G U R E 1 Schematic image of the procedures that were performed. The left image depicts the colonic manometry catheter (dotted line) that was placed into the colonic lumen.…”