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CHILD CONSTIPATION ABDOMINAL RADIOGRAPH
Category: Pediatric Surgery
Abstract : Abdominal Radiograph and Transit Time An abdominal radiograph is not
indicated to establish the presence of a fecal impaction if the rectal exam
reveals the presence of large amounts of stool. A retrospective study in
encopretic children showed thatmoderate to large amounts of stool found on
rectal examination had a high sensitivity and positive predictive value (greater
than 80%) for
Abdominal Radiograph and Transit Time
An abdominal radiograph is not
indicated to establish the presence of a fecal impaction if the rectal exam
reveals the presence of large amounts of stool.
A retrospective study in
encopretic children showed thatmoderate to large amounts of stool found on
rectal examination had a high sensitivity and positive predictive value (greater
than 80%) for predicting fecal retention determined by abdominal radiograph,
even using the radiologists subjective interpretation.
However, the
specificity and negative predictive value were 50% or less. When the systematic
scoring system developed by Barr was used for the presence of fecal
retention on radiograph, the sensitivity of moderate to large amounts of stool
on rectal examination improved to 92%, and the positive predictive value was
94%.
However, the specificity was still only 71% and the negative
predictive value was only 62%. This suggests that, when there is doubt about
whether the patient is constipated, a plain abdominal radiograph is reliable in
determining the presence of fecal retention in the child who is obese or refuses
a rectal exam, or in whom there are other psychological factors (sexual abuse)
that make the rectal examination too traumatic. It may also be helpful in the
child with a good history for constipation who does not have large amounts of
stool on rectal examination.
In a recent study the value of the Barr
Score was compared to the colonic transit time. The Barr Score was shown to be
poorly reproducible, with low inter-observer and intraobserver reliability, and
there was no correlation with measurements of transit time. Some patients have a
history of infrequent bowel movements, but have no objective findings of
constipation. The history obtained from the parents and child may not be
entirely accurate. In these patients an evaluation of colonic transit time with
radio-opaque markers may be helpful.
The quantification of transit time
shows whether constipation is present and provides an objective evaluation of
bowel movement frequency. If the transit time is normal, the child does not have
constipation. If the transit time is normal and there is no soiling, the child
needs no further evaluation.
For children who have soiling without
evidence of constipation the best results have been achieved with behavioral
modification, but in some instances psychological evaluation and treatment may
be necessary. If the transit study is abnormal or a fecal impaction is present,
further evaluation will be needed. When a child with objective evidence of
constipation is refractory to treatment, it is important to consider
Hirschsprung disease.
Hit: 342 times
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