Transabdominal Ultrasound Measurement of the Diameter of Rectal Ampulla as a Less Invasive Modality for Digital Rectal Examination in Children with Functional Constipation

Imanzadeh, Farid; Hosseini, Amirhossein; Khalili, Mitra; Naghdi, Elaheh; Hajipour, Mahmoud; Yazdanifard, Parin; Alimoghadam, Shaya; Fateh, Sepand Tehrani; Aminzade, Zahra; Mohseni, Parisa; Fasihi, Mohammad Rasoul; Safari, Tayyebeh

doi:10.5812/ijp-114354

Cited by 4 publications

(2 citation statements)

References 19 publications

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“…It seems that factors affecting rectal diameter should be further studied as contradicting results are found, for example, frequency of defecation was stated to correlate with rectal diameter in some studies, 8,10 while faecal incontinence correlated to rectal diameter in other studies 15,19,20 but not by Shapouri et al 8 . who documented the relation to hard stools instead.…”

Section: Discussionmentioning

confidence: 93%

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The role of rectal ultrasound in children with functional constipation

Hamdy

Sakr

Awad

et al. 2023

J Paediatrics Child Health

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The study aimed primarily to compare the transverse rectal diameter in children with functional constipation (FC) and children without constipation in different age groups, and between cases of constipation at baseline and after treatment. Secondary aim was to determine factors that could affect the transverse rectal diameter. Methods: A controlled prospective study, including a total of 100 children between the ages of 2 and 11 years, who were divided into 50 patients suffering from constipation according to Rome IV criteria and 50 age-and sex-matched controls. Transverse rectal diameter was measured at presentation, and after 3 months of laxative therapy and behavioural modification. Results: Initial rectal diameter was significantly different between cases (3.55 cm (interquartile range, IQR), 3.2-4) and controls (2.3 cm (IQR, 1.8-2.5)), P value < 0.001, and it was also significantly different between those above and below 4 years, so a separate cut-off point for diagnosis of constipation was suggested being >3 cm for the former and >2.5 cm for the latter. After 3 months of follow-up, rectal diameter significantly reduced to become 2.6 (IQR, 2-2.8), P value < 0.001. Duration of symptoms positively correlated with rectal diameter. Conclusions: Ultrasound measurement of rectal diameter is an important tool to diagnose and follow-up functional constipation in children. Different values of rectal diameter are found between those above and below 4 years of age.

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Section: Discussionmentioning

confidence: 93%

“…who studied patients with spinal dysraphism, found that bowel management caused a decrease of rectal diameter by 56%. Duration of follow‐up ranged from 1 month 6,14,20 to 1 year 21 …”

Section: Discussionmentioning

confidence: 99%

The role of rectal ultrasound in children with functional constipation

Hamdy

Sakr

Awad

et al. 2023

J Paediatrics Child Health

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Accuracy of transabdominal ultrasound to diagnose functional constipation and fecal impaction in children: a systematic review and meta-analysis

Vos,

Bloem,

de Geus

et al. 2024

Pediatr Radiol

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Background Functional constipation is common in children and accurate diagnostic methods are essential for early diagnosis and effective management. The diagnostic accuracy of transabdominal ultrasound to diagnose functional constipation is unclear. Objective To evaluate the diagnostic accuracy of transverse rectal diameter measurement via transabdominal ultrasound in diagnosing children with functional constipation and in identifying fecal impaction. Materials and methods Electronic databases were searched from inception to March 2023. Original studies investigating the diagnostic accuracy of measuring transverse rectal diameter via transabdominal ultrasound, including children with and without functional constipation, or with and without fecal impaction were included. Data extraction and quality assessment were performed independently by two reviewers. Results Sixteen studies were included (n = 1,801 children, 0–17 years). Thirteen studies investigated the diagnostic accuracy for functional constipation, and five for fecal impaction. High risk of bias was found across the majority of studies mainly due to un-blinded case–control designs. Cut-off transverse rectal diameter values to diagnose functional constipation ranged from 2.4 cm to 3.8 cm. Meta-analysis (seven studies, n = 509 children) estimated mean sensitivity and specificity to diagnose functional constipation were 0.68 (95% confidence interval (CI) 0.55–0.78) and 0.81 (95% CI 0.71–0.88), respectively. Meta-analysis of diagnostic accuracy of identifying fecal impaction was not feasible. Studies reported a sensitivity and specificity ranging between 68–100% and 83–100%, respectively. Conclusion Transabdominal ultrasound may be a valuable non-invasive diagnostic tool to diagnose functional constipation by measuring transverse rectal diameter and identifying fecal impaction in children. Heterogeneous study methods and lack of age-dependent normal values impair current clinical recommendations. Future research should focus on separating age groups and developing a standardized protocol. Graphical Abstract

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Assessing fecal load with ultrasound in children with colorectal pathology: ReKiSo study

Erkel,

Märzheuser,

Lindert

2024

Pediatr Surg Int

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Purpose To evaluate bowel management for children with colorectal pathology by measuring transverse rectal diameter (TRD) and assessing fecal load with transabdominal rectal ultrasound (TRU). Methods Prospective case–control study of children receiving bowel management (BM) between 04/2023 and 04/2024 was done. There was inclusion of patients with Hirschsprung disease (HD), anorectal malformation (ARM) and functional constipation (FC). Patients with other congenital or neurological conditions were excluded. Control group consisted of inpatients and outpatients without abdominal complaints. FC was diagnosed according to ROM-IV-criteria. For HD and ARM, we followed a list of symptoms. To assess fecal load, we visualized the TRD using the Klijn (Klijn et al. in J Urol 172:1986–1988, 2004) method. The bladder was moderately full. The fecal load was assessed retrograde from the rectum. Follow-up was at 1/3/6 months. Secondary data were collected from medical records. Sample size calculated a priori and follow-up group with new gathered data. Results p value for TRD in all groups significant with p < 0.05 and in grouped follow-up. Conclusion Ultrasound is a useful tool for assessing fecal load and helps diagnose constipation and monitor BM. Irrespective of colorectal pathology, a cut-off of 3 cm seems to discriminate between children without constipation/overload symptoms and asymptomatic patients. We present a radiation-free method for monitoring bowel management.

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Transabdominal Ultrasound Measurement of the Diameter of Rectal Ampulla as a Less Invasive Modality for Digital Rectal Examination in Children with Functional Constipation

Cited by 4 publications

References 19 publications

The role of rectal ultrasound in children with functional constipation

The role of rectal ultrasound in children with functional constipation

Accuracy of transabdominal ultrasound to diagnose functional constipation and fecal impaction in children: a systematic review and meta-analysis

Assessing fecal load with ultrasound in children with colorectal pathology: ReKiSo study

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