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Functional constipation or redundancy of the colon?

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Abstract

Objectives

Constipation is a common problem in children, and most of the time, the cause is defined as functional. Our hypothesis is that children with functional refractory constipation had anatomic alterations of the colon.

Methods

All children with chronic refractory constipation who visited our centre underwent accurate clinical examination, contrast enema (CE), anorectal manometry (ARM) and rectal suction biopsies (RSB). In case of functional constipation, three operators measured the size of the colon using radiograms and calculated the ratio based on the width of the second lumbar vertebra. The measurements carried out were compared with those reported in the literature on patients of the same age without constipation.

Results

Over a period of 24 months, 69 patients with chronic refractory constipation, aged between 1 and 14 years, visited our department. A CE was performed on 67, and 2 were excluded because of anal stenosis. Sixty-five underwent anorectal manometry. Rectal suction biopsies were needed in 14 children, and 2 of them were found to have colonic aganglionosis. After a complete evaluation, 57 (82.61%) patients were diagnosed having functional constipation. By comparing the data of the patients with those of normal children reported by the other authors, we found that none of the measurements was statistically significant except for the rectosigmoid length: the mean value in one-year-old patients was 19.03 vs. 9.75, and in older children, it was 19.46 vs. 9.59.

Conclusions

Recognizing an anatomic anomaly in patients suffering from functional constipation is important for specific treatment, especially when the ratio (rectosigmoid length/L2) is higher than 15.

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Acknowledgments

We are grateful to Dr. Ilan Koppen for providing anonymized data from the previous study for comparison and for his valuable and constructive suggestions during the planning and development of this study.

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Authors and Affiliations

  1. Pediatric Surgery Unit, Salesi Children Hospital, Via Corridoni, 11, 60128, Ancona, Italy

    Carmine Noviello, Mercedes Romano & Giovanni Cobellis

  2. Department of Woman and Child Health and Public Health, Division of Neonatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, University Cattolica del Sacro Cuore, Rome, Italy

    Stefano Nobile

  3. Department of Radiological Sciences, Azienda Ospedaliero-Universitaria, Ancona, Italy

    Alessandra Mazzarini

  4. Pediatric Surgery Unit, Università degli Studi della Campania, Luigi Vanvitelli, Naples, Italy

    Alfonso Papparella

Authors
  1. Carmine Noviello
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  2. Stefano Nobile
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  3. Mercedes Romano
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  4. Alessandra Mazzarini
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  5. Alfonso Papparella
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  6. Giovanni Cobellis
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Corresponding author

Correspondence to Carmine Noviello.

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Conflict of interest

CN, SN, MR, AM, AP, and GC declare that they have no conflict of interest.

Ethics statement

The study was performed conforming to the Helsinki declaration of 1975, as revised in 2000 and 2008 concerning human and animal rights, and the authors followed the policy concerning informed consent as shown on Springer.com. The institutional review board approved the study.

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Noviello, C., Nobile, S., Romano, M. et al. Functional constipation or redundancy of the colon?. Indian J Gastroenterol 39, 147–152 (2020). https://doi.org/10.1007/s12664-020-01034-x

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  • DOI: https://doi.org/10.1007/s12664-020-01034-x

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