Journal of Pediatric Perspectives

Journal of Pediatric Perspectives

Ultrasound Evaluation of Gallbladder Mobility in Children with Chronic Functional Constipation

Document Type : original article

Authors
Mohammad Mehdi Ahmadi 1
Mohammad Ghasem Hanafi 2
Mohammad Momengharibvand 1
Hazhir Javaherizadeh 3
1 Department of Radiology, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
2 Department of Radiology, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
3 Department of Pediatric, Faculty of Medicine,Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
10.22038/ijp.2021.53749.4263
Abstract
Background: Constipation as a common disease in children can cause significant complications for this age group, so that one third of children have chronic symptoms which may continue into adulthood. The causes of chronic functional constipation are largely unknown; and it may be a multifactorial disorder. Gallbladder dysfunction in chronic idiopathic constipation may be an underlying cause of idiopathic constipation. Hence, this study aimed to evaluate the gallbladder mobility ultrasound in children with chronic functional constipation in Imam Khomeini Hospital of Ahvaz.
Methods: Children between the ages of 3 to 13 years in Imam Khomeini Hospital of Ahvaz, who suffered from functional constipation, were visited by a pediatric digestive and liver subspecialty physician after referring to the pediatric gastroenterology clinic of the hospital and were referred to us for conducting gallbladder ultrasound. In this study, 50 patients with chronic functional constipation and 50 healthy individuals (control group) were studied.
Results: The mean age of the participants in this study was 6.96 with a standard deviation of 2.44 years. In this study, 40 patients (40%) were boys and 60 patients (60%) were girls. The mean volume of gallbladder in fasting mode (preprandial) and after meal (postprandial) in individuals of the case group were 5.66 and 4.17 cm3 with standard deviations of 0.80 and 0.64, respectively, and in the control group were 6.08 and 3.06 cm3 with standard deviations of 0.97 and 0.75, respectively. The thickness of the gallbladder wall in the fasting mode (preprandial) and after meal (postprandial) in the case group was 1.50 and 1.67 mm with standard deviations of 0.24 and 0.29 mm, respectively, and in the control group, it is equal to 1.39 and 1.69 with standard deviations of 0.22 and 0.28, respectively.
A significant relationship was observed between case and control groups (P <0.05) in terms of gallbladder volume after meals, but no significant relationship was found between gallbladder volume and the gallbladder wall thickness in the fasting mode and after meal in neither of the case and control groups (P> 0.05).
Conclusion: Due to the slow mobility of the gallbladder in patients with chronic functional constipation, it can be concluded that gallbladder dysfunction can be a cause of chronic functional constipation.
Keywords
Chronic functional constipation
Ultrasound
Gallbladder
  1. Kamm MA. Constipation and its management. BMJ. 2003; 327:459–460. doi: 10.1136/bmj.327.7413.459.
  2. Loening-Baucke V. Constipation in children. N Engl J Med. 1998; 339:1155–1156. doi: 10.1056/NEJM199810153391610.
  3. Youssef NN, Di Lorenzo C. Childhood constipation: evaluation and treatment. J Clin Gastroenterol. 2001; 33:199–205. doi: 10.1097/00004836-200109000-00006.
  4. van Ginkel R, Reitsma JB, Buller HA, van Wijk MP, Taminiau JA, Benninga MA. Childhood constipation: longitudinal follow-up beyond puberty. Gastroenterology. 2003; 125:357–363. doi: 10.1016/S0016-5085(03)00888-6.
  5. Procter E, Loader P. A 6-year follow-up study of chronic constipation and soiling in a specialist pediatric service. Child Care Health Dev. 2003; 29:103–109. doi: 10.1046/j.1365-2214.2003.00319.x.
  6. Camilleri M, Fealey RD. Idiopathic autonomic denervation in eight patients presenting with functional gastrointestinal disease: a causal association? Dig Dis Sci. 1990; 35:609–616. doi: 10.1007/BF01540409.
  7. J R van der Sijp, M A Kamm, J M Nightingale, K E Britton, M Granowska, S J Mather, L M Akkermans, J E Lennard-Jones. Disturbed gastric and small bowel transit in severe idiopathic constipation. Dig Dis Sci. 1993; 38:837–844. doi: 10.1007/BF01295909.
  8. Kerrigan DD, Lucas MG, Sun WM, Donnelly TC, Read NW. Idiopathic constipation associated with impaired urethrovesical and sacral reflex function. Br J Surg. 1989; 76:748–751. doi: 10.1002/bjs.1800760735.
  9. A Watier, G Devroede, A Duranceau, M Abdel-Rahman, C Duguay, M D Forand, L Tétreault, P Arhan, J Lamarche, M Elhilali. Constipation with colonic inertia: a manifestation of systemic disease? Dig Dis Sci. 1983; 28:1025–1033. doi: 10.1007/BF01311732.
  10. Krishnamurthy S, Schuffler MD, Rohrmann CA, Pope CE., 2nd Severe idiopathic constipation is associated with a distinctive abnormality of the colonic myenteric plexus. Gastroenterology. 1985; 88:26–34. doi: 10.1016/S0016-5085(85)80128-1.
  11. Alp Gunay, A Kemal Gurbuz, Yavuz Narin, A Melih Ozel, Y Yazgan. Gallbladder motility in patients with chronic idiopathic slow transit constipation. Turk J Gastroenterol. 2001; 12:274–280.
  12. Boccia G, Buonavolontà R, Coccorullo P, Manguso F, Fuiano L, Staiano A. Dyspeptic symptoms in children: the result of a constipation-induced cologastric brake? Clin Gastroenterol Hepatol. 2008; 6:556–560. doi: 10.1016/j.cgh.2008.01.001.
  13. Hemingway D, Neilly JB, Finlay IG. Biliary dyskinesia in idiopathic slow-transit constipation. Dis Colon Rectum. 1996; 39:1303–1307. doi: 10.1007/BF02055128.
  14. Günay A, Gürbüz AK, Narin Y, Ozel AM, Yazgan Y. Gallbladder and gastric motility in patients with idiopathic slow-transit constipation. South Med J. 2004; 97:124–128. doi: 10.1097/01.SMJ.0000100265.49370.AD.
  15. Benninga MA, Buller HA, Tytgat GN, Akkermans LM, Bossuyt PM, Taminiau JA. Colonic transit time in constipated children: does pediatric slow-transit constipation exist? J Pediatr Gastroenterol Nutr. 1996; 23:241–251. doi: 10.1097/00005176-199610000-00007.
  16. Shin YM, Southwell BR, Stanton MP, Hutson JM. Signs and symptoms of slow-transit constipation versus functional retention. J Pediatr Surg. 2002; 37:1762–1765. doi: 10.1053/jpsu.2002.36716.
  17. Penning C, Gielkens HA, Delemarre JB, Lamers CB, Masclee AA. Gall bladder emptying in severe idiopathic constipation. Gut. 1999; 45:264–268. doi: 10.1136/gut.45.2.264.
  18. Veras Neto MC, Yamada RM, da Costa Pinto EA. Gallbladder motility in children with chronic constipation. J Pediatr Gastroenterol Nutr. 2008; 46:414–418. doi: 10.1097/MPG.0b013e31813347c4.
  19. Davion T, Tossou H, Delamarre J, Capron JP. Racial differences in gallbladder motor function. Lancet. 1989; 333:724–725. doi: 10.1016/S0140-6736(89)92236-8.
  20. Lehtonen L, Svedström E, Korvenranta H. The size and contractility of the gallbladder in infants. Pediatr Radiol. 1992; 22:515–518. doi: 10.1007/BF02012998.
  21. J R van der Sijp, M A Kamm, J M Nightingale, L M Akkermans, M A Ghatei, S R Bloom, J B Jansen, J E Lennard-Jones. Circulating gastrointestinal hormone abnormalities in patients with severe idiopathic constipation. Am J Gastroenterol. 1998; 93:1351–1356. doi: 10.1016/S0002-9270(98)00226-3.
  22. Di Ciaula A, Wang DQ, Portincasa P. Gallbladder and gastric motility in obese newborns, pre-adolescents and adults. J Gastroenterol Hepatol. 2012; 27:1298–1305. doi: 10.1111/j.1440-1746.2012.07149.x.

23. Rakesh Mehra, Kushaljit Singh Sodhi, Akshay Saxena, BR Thapa, and Niranjan Khandelwal. Sonographic Evaluation of Gallbladder Motility in Children with Chronic Functional Constipation. Gut Liver. 2015 May; 9(3): 388–394.

Journal of Pediatric Perspectives
Volume 10, Issue 2
February 2022
Pages 15370-15376