Document Type : original article
Authors
1 Department of Pediatrics, Clinical Research Development Unit, Hajar Hospital, Shahrekord University of Medical Sciences, Shahrekord, Iran.
2 Clinical Research Development Unit, Hajar Hospital, Shahrekord University of Medical Science, Shahrekord, Iran.
3 Department of Epidemiology and Biostatistics, School of Health, Shahrekord University of Medical Sciences, Shahrekord, Iran.
Abstract
Background: In diagnosing and tracking fecal impaction in children with functional constipation, a variety of methods such as history taking, physical examination, digital rectal examination (DRE), and, if needed, imaging-based methods are used. However, the most effective method for tracking this condition remains unclear. Our objective was to evaluate the agreement of medical history and DRE with trans-abdominal radiography as the gold standard for diagnosing childhood fecal impaction.
Material and Methods: In this cross-sectional study, two subgroups of children aged 4 to 10 years with and without fecal impaction were included and evaluated through physical examination, DRE, and trans-abdominal radiography (as the standard), along with a detailed medical history.
Results: The positive abdominal examination in the groups with and without fecal impaction was 33.5% and 7.9%, respectively, indicating a significant difference (p < 0.001). In the groups with and without fecal impaction, positive medical history related to functional constipation was revealed in 85.3% and 4.2%, respectively, indicating a significant difference (p <0.001). Also, in the DRE method, compared to abdominal radiography, fecal impaction was positive in 85.9% of patients with fecal impact. In comparison, only 8.5% of the control group indicated a significant difference (p < 0.001).
Conclusion: A combination of history taking, DRE, and, if necessary, abdominal radiography should be considered to diagnose fecal impaction in children with functional constipation.
Keywords
- Hussain ZH, Whitehead DA, Lacy BE. Fecal impaction. Current gastroenterology reports. 2014 Sep;16:1-7.
- Wester T. Functional constipation in children: the pediatric surgeon’s perspective. Pediatric surgery international. 2013 Sep;29:883-7.
- Chowdhury K, Sinha S, Kumar S, Haque M, Ahmad R. Constipation: A Pristine Universal Pediatric Health Delinquent. Cureus. 2024 Jan;16(1).
- Mulhem E, Khondoker F, Kandiah S. Constipation in children and adolescents: evaluation and treatment. American family physician. 2022 May;105(5):469-78.
- Makhwana VA, Acharyya K, Acharyya S. Profile of functional constipation in children at a referral hospital. Indian Pediatrics. 2022 Apr;59(4):287-9.
- Härter B, Scholl-Bürgi S. Abdominal Pain and Constipation. Gastroenterology. 2019 Feb 1;156(3):e12-3.
- Mouterde O. Constipation in infants and children: How should it be treated?. Archives de Pediatrie: Organe Officiel de la Societe Francaise de Pediatrie. 2016 Apr 23;23(6):664-7.
- Corban C, Sommers T, Sengupta N, Jones M, Cheng V, Friedlander E, et al. Fecal impaction in the emergency department: an analysis of frequency and associated charges in 2011. Journal of clinical gastroenterology. 2016 Aug 1;50(7):572-7.
- Vos JM, Bloem MN, de Geus A, Leeflang MM, Spijker R, Koppen IJ, et al. Accuracy of transabdominal ultrasound to diagnose functional constipation and fecal impaction in children: a systematic review and meta-analysis. Pediatric Radiology. 2024 Nov 15:1-6.
- Koppen IJ, Vriesman MH, Saps M, Rajindrajith S, Shi X, van Etten-Jamaludin FS, et al. Prevalence of functional defecation disorders in children: a systematic review and meta-analysis. The Journal of pediatrics. 2018 Jul 1;198:121-30.
- Cunha TB, Tahan S, Soares MD, Lederman HM, Morais MB. Abdominal radiograph in the assessment of fecal impaction in children with functional constipation: comparing three scoring systems. Jornal de Pediatria. 2012;88:317-22.
- Rodriguez DA, Dahlwi G, Gould M, Marcon M, Benninga M. The Diagnostic Accuracy of Abdominal X-ray in Childhood Constipation: A Systematic Review of the Literature. Gastrointestinal Disorders. 2024 Jan 9;6(1):94-102.
- Araghizadeh F. Fecal impaction. Clinics in colon and rectal surgery. 2005 May;18(02):116-9.
- Modin L, Walsted AM, Jakobsen MS. Identifying faecal impaction is important for ensuring the timely diagnosis of childhood functional constipation. Acta Paediatrica. 2015 Aug;104(8):838-42.
- Burgers R, de Jong TP, Benninga MA. Rectal examination in children: digital versus transabdominal ultrasound. The Journal of urology. 2013 Aug 1;190(2):667-72.
- Pradhan S, Jagadisan B. Yield and examiner dependence of digital rectal examination in detecting impaction in pediatric functional constipation. Journal of Pediatric Gastroenterology and Nutrition. 2018 Nov 1;67(5):570-5.
- Gold DM, Levine J, Weinstein TA, Kessler BH, Pettei MJ. Frequency of digital rectal examination in children with chronic constipation. Archives of pediatrics & adolescent medicine. 1999 Apr 1;153(4):377-9.
- Reuchlin-Vroklage LM, Bierma-Zeinstra S, Benninga MA, Berger MY. Diagnostic value of abdominal radiography in constipated children: a systematic review. Archives of pediatrics & adolescent medicine. 2005 Jul 1;159(7):671-8.