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Erkel D, Märzheuser S, Lindert J. Assessing fecal load with ultrasound in children with colorectal pathology: ReKiSo study. Pediatr Surg Int 2024; 40:202. [PMID: 39030300 PMCID: PMC11271418 DOI: 10.1007/s00383-024-05771-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/04/2024] [Indexed: 07/21/2024]
Abstract
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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Affiliation(s)
- Daniel Erkel
- Department of Pediatric Surgery, University Hospital Rostock, Ernst-Heydemann-Straße 8, 18057, Rostock, Germany.
| | - Stefanie Märzheuser
- Department of Pediatric Surgery, University Hospital Rostock, Ernst-Heydemann-Straße 8, 18057, Rostock, Germany
| | - Judith Lindert
- Department of Pediatric Surgery, University Hospital Rostock, Ernst-Heydemann-Straße 8, 18057, Rostock, Germany
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2
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Mathias RM, Chu MKW, Edwards S, Day AS, Ma C, Jairath V, Bryant RV. Meta-analysis: Intestinal ultrasound to evaluate colonic contents and constipation. Aliment Pharmacol Ther 2024; 60:6-16. [PMID: 38745540 DOI: 10.1111/apt.18029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 01/02/2024] [Accepted: 04/18/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND Constipation can be diagnosed clinically using the Rome criteria. Ultrasound (US), which lacks the radiation exposure of conventional X-ray, holds promise as a non-invasive tool to evaluate colonic contents and constipation. AIM To examine the role of US in the assessment of constipation. METHODS We performed a systematic search of Embase (OVID, 1984), Medline (Ovid, 1946), Cochrane Central, ClinicalTrials.gov and Australia New Zealand Clinical Trials Registry from database inception to 26 January 2024 according to PRISMA guidelines and prospectively registered with PROSPERO. All studies using US to assess constipation or colonic contents in either adults or children were included. Rectal diameter measurements were pooled in meta-analysis. Risk of bias was assessed using the Newcastle Ottawa Scales and Joanna Briggs Institute checklists. RESULTS Of 12,232 studies screened, 51 articles (6084 patients; 3422 children) describing US to assess symptoms in patients with constipation were included. Most studies used Rome criteria to diagnose constipation. Rectal diameter was associated with clinical constipation in 29 paediatric studies (3331 patients). Meta-analysis showed the mean rectal diameter of constipated patients was significantly higher than controls (mean difference 12 mm, 95% confidence intervals (CI): 6.48, 17.93, p < 0.0001, n = 16 studies). Other features of constipation on US included posterior acoustic shadowing and echogenicity of luminal contents. CONCLUSION US is an appealing imaging modality to assess luminal contents and constipation. Further well-designed studies are required to validate US metrics that accurately identify constipation.
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Affiliation(s)
- R M Mathias
- Inflammatory Bowel Disease Service, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia
- Inflammatory Bowel Disease Research Group, The Basil Hetzel Institute for Translational Health Research, Adelaide, South Australia, Australia
- School of Medicine, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - M K W Chu
- Inflammatory Bowel Disease Service, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia
- Inflammatory Bowel Disease Research Group, The Basil Hetzel Institute for Translational Health Research, Adelaide, South Australia, Australia
- School of Medicine, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - S Edwards
- School of Public Health, The University of Adelaide, Adelaide, South Australia, Australia
| | - A S Day
- Inflammatory Bowel Disease Service, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia
- Inflammatory Bowel Disease Research Group, The Basil Hetzel Institute for Translational Health Research, Adelaide, South Australia, Australia
- School of Medicine, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - C Ma
- Division of Gastroenterology & Hepatology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Alimentiv Inc., London, Ontario, Canada
| | - V Jairath
- Alimentiv Inc., London, Ontario, Canada
- Division of Gastroenterology, Department of Medicine, London Health Sciences Centre, Western University, London, Ontario, Canada
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | - R V Bryant
- Inflammatory Bowel Disease Service, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia
- Inflammatory Bowel Disease Research Group, The Basil Hetzel Institute for Translational Health Research, Adelaide, South Australia, Australia
- School of Medicine, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
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Caruso AM, Bommarito D, Girgenti V, Amato G, Calabrese U, Figuccia A, Baldanza F, Grasso F, Giglione E, Casuccio A, Milazzo MPM, Di Pace MR. Evaluation of Anal Sphincter with High Resolution Anorectal Manometry and 3D Reconstruction in Patients with Anorectal Malformation. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1037. [PMID: 37371268 DOI: 10.3390/children10061037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 05/27/2023] [Accepted: 06/01/2023] [Indexed: 06/29/2023]
Abstract
BACKGROUND Patients with anorectal malformation (ARM) need long-term follow-up, in order to evaluate fecal continence; the main predictors of longer-term success are the type of ARM, associated anomalies and sacral integrity. Three-Dimensional High Resolution Anorectal Manometry (3D-HRAM) gives detailed information on pressure on the anal complex profile. Our objective was to analyze anal sphincter activity in ARM patients with 3D-HRAM establishing the correlation between manometric and clinical data. METHODS Forty ARM patients were submitted to 3D-HRAM: manometric, anatomical and clinical scores were correlated with each other and with the bowel management response (BM). RESULTS A positive correlation between all scores and types of ARM was found: in high ARM and in patients with spinal anomalies (regardless to ARM type) lower scores were reported and even after BM they did not achieve good continence. CONCLUSIONS 3D-HRAM gives detailed data on the functional activity of the anal sphincter complex. Our study revealed a correlation between manometric parameters and clinical outcomes, confirming spinal malformations and ARM type as the most important prognostic risk factors for a bad outcome. Specific sphincteric defects can also be explored with manometry, allowing for tailored bowel management strategies.
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Affiliation(s)
- Anna Maria Caruso
- Pediatric Surgical Unit, Children's Hospital 'G. di Cristina', ARNAS Civico, 90100 Palermo, Italy
| | - Denisia Bommarito
- Pediatric Surgical Unit, Children's Hospital 'G. di Cristina', ARNAS Civico, 90100 Palermo, Italy
| | - Vincenza Girgenti
- Pediatric Surgical Unit, Children's Hospital 'G. di Cristina', ARNAS Civico, 90100 Palermo, Italy
| | - Glenda Amato
- Pediatric Surgical Unit, Children's Hospital 'G. di Cristina', ARNAS Civico, 90100 Palermo, Italy
| | - Ugo Calabrese
- Pediatric Surgical Unit, Children's Hospital 'G. di Cristina', ARNAS Civico, 90100 Palermo, Italy
| | - Adele Figuccia
- Pediatric Surgical Unit, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialities, University of Palermo, 90100 Palermo, Italy
| | - Fabio Baldanza
- Pediatric Surgical Unit, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialities, University of Palermo, 90100 Palermo, Italy
| | - Francesco Grasso
- Pediatric Surgical Unit, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialities, University of Palermo, 90100 Palermo, Italy
| | - Emanuela Giglione
- Pediatric Surgery Division, Women's and Children's Health Department, University of Padua, 35100 Padua, Italy
| | - Alessandra Casuccio
- Pediatric Surgical Unit, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialities, University of Palermo, 90100 Palermo, Italy
| | | | - Maria Rita Di Pace
- Pediatric Surgical Unit, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialities, University of Palermo, 90100 Palermo, Italy
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Hamdy AM, Sakr HM, Boules IS, Awad YMM. The role of rectal ultrasound in children with functional constipation. J Paediatr Child Health 2023; 59:533-536. [PMID: 36718568 DOI: 10.1111/jpc.16344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 01/12/2023] [Accepted: 01/14/2023] [Indexed: 02/01/2023]
Abstract
AIM 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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Affiliation(s)
- Ahmed M Hamdy
- Department of Pediatrics, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Hossam M Sakr
- Radiology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Ireny S Boules
- Department of Pediatrics, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Yosra M M Awad
- Department of Pediatrics, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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Matsumoto M, Misawa N, Tsuda M, Manabe N, Kessoku T, Tamai N, Kawamoto A, Sugama J, Tanaka H, Kato M, Haruma K, Sanada H, Nakajima A. Expert Consensus Document: Diagnosis for Chronic Constipation with Faecal Retention in the Rectum Using Ultrasonography. Diagnostics (Basel) 2022; 12:diagnostics12020300. [PMID: 35204390 PMCID: PMC8871156 DOI: 10.3390/diagnostics12020300] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 01/10/2022] [Accepted: 01/15/2022] [Indexed: 12/12/2022] Open
Abstract
Chronic constipation is a common gastrointestinal disorder in older adults, and it is very important to manage chronic constipation. However, evaluating these subjective symptoms is extremely difficult in cases where patients are unable to express their symptoms because of a cognitive or physical impairment. Hence, it is necessary to observe the patient’s colonic faecal retention using objective methods. Ultrasonography observation for colonic faecal retention is useful for diagnosing constipation and evaluating the effectiveness of treatment. Since there was no standard protocol for interpreting rectal ultrasonography findings, we developed an observation protocol through an expert consensus. We convened a group of experts in the diagnosis and evaluation of chronic constipation and ultrasonography to discuss and review the current literature on this matter. Together, they composed a succinct, evidence-based observation protocol for rectal faecal retention using ultrasonography. We created an observation protocol to enhance the quality and accuracy of diagnosis of chronic constipation, especially rectal constipation. This consensus statement is intended to serve as a guide for physicians, laboratory technicians and nurses who do not specialise in ultrasound or the diagnosis of chronic constipation.
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Affiliation(s)
- Masaru Matsumoto
- School of Nursing, Ishikawa Prefectural Nursing University, 1-1 Gakuendai, Kahoku 929-1210, Japan;
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan;
| | - Noboru Misawa
- Department of Gastroenterology and Hepatology, School of Medicine, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama 236-0004, Japan; (N.M.); (T.K.)
| | - Momoko Tsuda
- Department of Gastroenterology, National Hospital Organization Hakodate National Hospital, 18-16 Kawahara-cho, Hakodate 041-8512, Japan; (M.T.); (M.K.)
| | - Noriaki Manabe
- Division of Endoscopy and Ultrasonography, Department of Clinical Pathology and Laboratory Medicine, Kawasaki Medical School, 2-6-1 Nakasange, Kita-ku, Okayama 700-8505, Japan; (N.M.); (K.H.)
| | - Takaomi Kessoku
- Department of Gastroenterology and Hepatology, School of Medicine, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama 236-0004, Japan; (N.M.); (T.K.)
- Department of Palliative Medicine, Yokohama City University Hospital, 3-9 Fukuura, Kanazawa-ku, Yokohama 236-0004, Japan
| | - Nao Tamai
- Department of Imaging Nursing Science, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan;
- Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Atsuo Kawamoto
- Division of Ultrasound and Department of Diagnostic Imaging, Tokyo Medical University Hospital, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo 160-0023, Japan;
| | - Junko Sugama
- Research Center for Implementation Nursing Science Initiative, School of Health Sciences, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake 470-1192, Japan;
| | - Hideko Tanaka
- School of Nursing, College of Nursing and Nutrition, Shukutoku University, 673 Nitona-cho, Chuo-ku, Chiba City 260-8703, Japan;
| | - Mototsugu Kato
- Department of Gastroenterology, National Hospital Organization Hakodate National Hospital, 18-16 Kawahara-cho, Hakodate 041-8512, Japan; (M.T.); (M.K.)
| | - Ken Haruma
- Division of Endoscopy and Ultrasonography, Department of Clinical Pathology and Laboratory Medicine, Kawasaki Medical School, 2-6-1 Nakasange, Kita-ku, Okayama 700-8505, Japan; (N.M.); (K.H.)
| | - Hiromi Sanada
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan;
- Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Atsushi Nakajima
- Department of Gastroenterology and Hepatology, School of Medicine, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama 236-0004, Japan; (N.M.); (T.K.)
- Correspondence: ; Tel.: +81-45-787-2640
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McGinness A, Lin-Martore M, Addo N, Shaahinfar A. The unmet demand for point-of-care ultrasound among general pediatricians: a cross-sectional survey. BMC MEDICAL EDUCATION 2022; 22:7. [PMID: 34980087 PMCID: PMC8722332 DOI: 10.1186/s12909-021-03072-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 12/01/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Point-of-care ultrasound (POCUS) is a noninvasive bedside tool with many pediatric applications but is not currently a formal part of pediatric training and practice. Formal surveys of general pediatricians regarding POCUS training are lacking. We aimed to quantify the baseline ultrasound experience and training needs of general pediatricians and pediatric residents across different practice settings. METHODS In 2020, we sent an online survey to 485 current faculty, residents, and graduates from an urban pediatric academic medical center in Northern California. Pediatric subspecialists were excluded. Survey questions about baseline experience, comfort, and perceived usefulness of 20 common POCUS applications were developed by two POCUS experts using existing literature. Chi-squared analysis was used to compare residents versus attendings and to compare attendings practicing in inpatient versus outpatient versus mixed settings. RESULTS Response rate was 20% (98/485). Compared to attendings (n = 73), residents (n = 25) endorsed more exposure to POCUS in medical school (32% vs 5%, p = 0.003) and residency (12% vs 5%, p = 0.003). Respondents endorsed low comfort with POCUS (mean 1.3 out of 5 on Likert scale). Of 20 procedural and diagnostic applications, respondents identified abscess drainage, bladder catheterization, soft tissue, neck, advanced abdominal, and constipation as most useful. Overall, 50% of pediatricians (and 70% of pediatric residents) responded that there were opportunities to use POCUS multiple times a week or more in their clinical practice. CONCLUSIONS There is an unmet demand for POCUS training among general pediatricians and trainees in our study. Although the majority of respondents were not POCUS users, our results could guide future efforts to study the role of POCUS in general pediatrics and develop pediatric curricula.
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Affiliation(s)
- Anelah McGinness
- Department of Graduate Medical Education, PGY-3 resident, University of California San Francisco Benioff Children’s Hospital Oakland, 747 52nd Street, Suite 245, Oakland, CA 94609 USA
| | - Margaret Lin-Martore
- Departments of Emergency Medicine and Pediatrics, University of California San Francisco, 5150 16th St, Box 0632, San Francisco, CA 94143 USA
| | - Newton Addo
- Departments of Medicine and Emergency Medicine, 1001 Potrero Ave, Box 1220, San Francisco, CA 94143 USA
| | - Ashkon Shaahinfar
- Departments of Emergency Medicine and Pediatrics, University of California San Francisco Benioff Children’s Hospital Oakland, University of California San Francisco, 747 52nd Street, ED Trailer 3, Oakland, CA 94609 USA
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Advanced Management Protocol of Transanal Irrigation in Order to Improve the Outcome of Pediatric Patients with Fecal Incontinence. CHILDREN 2021; 8:children8121174. [PMID: 34943370 PMCID: PMC8700212 DOI: 10.3390/children8121174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 11/18/2021] [Accepted: 12/08/2021] [Indexed: 11/16/2022]
Abstract
Background: Transanal irrigation (TAI) is employed for children with fecal incontinence, but it can present several problems which require a study of their outcomes among different pathologies and without a tailored work up. The aim of our study was to evaluate the effectiveness of an advanced protocol in order to tailor TAI, prevent complications, and evaluate outcomes. Methods: We included 70 patients (14 anorectal malformation, 12 Hirschsprung’s disease, 24 neurological impairment, 20 functional incontinence) submitted to a comprehensive protocol with Peristeen®: fecal score, volumetric enema, rectal ultrasound, anorectal 3D manometry, and diary for testing and parameter adjustment. Results: Among the patients, 62.9% needed adaptations to the parameters, mainly volume of irrigated water and number of puffs of balloon. These adaptations were positively correlated with pre-treatment manometric and enema data. In each group, the improvement of score was statistically significant in all cases (p 0.000); the main factor influencing the efficacy was the rate of sphincter anomalies. The ARM group had slower improvement than other groups, whereas functional patients had the best response. Conclusions: Our results showed that TAI should not be standardized for all patients, because each one has different peculiarities; evaluation of patients before TAI with rectal ultrasound, enema, and manometry allowed us to tailor the treatment, highlighting different outcomes among various pathologies, thus improving the efficacy.
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Pop D, Tătar S, Fufezan O, Farcău D. Rectum sizes: Assessment by ultrasonography in children with functional constipation. J Paediatr Child Health 2021; 57:1244-1249. [PMID: 33665902 DOI: 10.1111/jpc.15435] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 01/30/2021] [Accepted: 02/23/2021] [Indexed: 12/27/2022]
Abstract
AIM This study aimed to compare the transverse diameter and thickness of the anterior wall of the rectum in children with normal bowel movement and children with functional constipation in different age groups. Another objective was to find correlations of rectum sizes with faecal incontinence and constipation duration. METHODS In the study, we included children with normal bowel movement and functional constipation diagnosed based on the Rome III and Rome IV criteria. We collected clinical data from the parents. We measured the rectum transverse diameter and the thickness of the anterior wall by abdominal ultrasound. RESULTS The study included 65 children, 31 with normal bowel movement and 34 with functional constipation. The rectum transverse diameter and the thickness of the anterior wall had statistically significant higher values in patients with constipation (P < 0.05). There was a moderate and significant correlation between the duration of the disease (mean ± standard deviation = 31.7 ± 33.1 months) and rectum transverse diameter (r = 0.54; P = 0.0009). The rectum transverse diameter correlated moderately with the presence of faecal incontinence (r = 0.62; P = 0.003), but the thickness of the anterior wall did not correlate with this symptom (r = 0.02; P = 0.39). CONCLUSIONS We found statistically significant differences between the transverse rectal diameter and thickness of the rectum anterior wall, measured by abdominal ultrasound, in children with functional constipation compared with normal defaecation patterns. Faecal incontinence and long-term constipation were correlated with the increased rectum diameter.
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Affiliation(s)
- Daniela Pop
- 3rd Pediatric Discipline, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Simona Tătar
- 3rd Pediatric Department, Clinical Emergency Hospital for Children, Cluj-Napoca, Romania
| | - Otilia Fufezan
- Radiology Department, Clinical Emergency Hospital for Children, Cluj-Napoca, Romania
| | - Dorin Farcău
- 3rd Pediatric Department, Clinical Emergency Hospital for Children, Cluj-Napoca, Romania.,Nursing Discipline, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
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9
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Matsumoto M, Tsutaoka T, Nakagami G, Tanaka S, Yoshida M, Miura Y, Sugama J, Okada S, Ohta H, Sanada H. Deep learning-based classification of rectal fecal retention and analysis of fecal properties using ultrasound images in older adult patients. Jpn J Nurs Sci 2020; 17:e12340. [PMID: 32394621 DOI: 10.1111/jjns.12340] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 02/02/2020] [Accepted: 03/13/2020] [Indexed: 11/30/2022]
Abstract
AIM The present study aimed to analyze the use of machine learning in ultrasound (US)-based fecal retention assessment. METHODS The accuracy of deep learning techniques and conventional US methods for the evaluation of fecal properties was compared. The presence or absence of rectal feces was analyzed in 42 patients. Eleven patients without rectal fecal retention on US images were excluded from the analysis; thus, fecal properties were analyzed in 31 patients. Deep learning was used to classify the transverse US images into three types: absence of feces, hyperechoic area, and strong hyperechoic area in the rectum. RESULTS Of the 42 patients, 31 tested positive for the presence of rectal feces, zero were false positive, zero were false negative, and 11 were negative, indicating a sensitivity of 100% and a specificity of 100% for the detection of rectal feces in the rectum. Of the 31 positive patients, 14 had hard stools and 17 had other types. Hard stool was detected by US findings in 100% of the patients (14/14), whereas deep learning-based classification detected hard stool in 85.7% of the patients (12/14). Other stool types were detected by US findings in 88.2% of the patients (15/17), while deep learning-based classification also detected other stool types in 88.2% of the patients (15/17). CONCLUSIONS The results showed that US findings and deep learning-based classification can detect rectal fecal retention in older adult patients and distinguish between the types of fecal retention.
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Affiliation(s)
- Masaru Matsumoto
- Department of Imaging Nursing Science, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Takuya Tsutaoka
- Department of Imaging Nursing Science, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Gojiro Nakagami
- Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Department of Gerontological Nursing / Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Shiho Tanaka
- Department of Gerontological Nursing / Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Mikako Yoshida
- Department of Women's Health Nursing & Midwifery, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Yuka Miura
- Department of Imaging Nursing Science, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Junko Sugama
- Institute for Frontier Science Initiative, Kanazawa University, Ishikawa, Japan
| | - Shingo Okada
- Department of Surgery, Kitamihara Clinic, Hokkaido, Japan
| | - Hideki Ohta
- Medical Corporation Activities Supporting Medicine: Systematic Services (A.S.M.ss), Tochigi, Japan
| | - Hiromi Sanada
- Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Department of Gerontological Nursing / Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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MOMENI M, MOMEN-GHARIBVAND M, KULOUEE N, JAVAHERIZADEH H. ULTRASONOGRAPHY IN DETERMINING THE RECTAL DIAMETER AND RECTAL WALL THICKNESS IN CHILDREN WITH AND WITHOUT CONSTIPATION: A CASE-CONTROL STUDY. ARQUIVOS DE GASTROENTEROLOGIA 2019; 56:84-87. [DOI: 10.1590/s0004-2803.201900000-19] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 03/13/2019] [Indexed: 12/12/2022]
Abstract
ABSTRACT BACKGROUND: Ultrasonography has shown to be useful in the diagnosis of constipation. OBJECTIVE: The aim of this study was to compare the rectal diameter and rectal wall thickness in children with and without constipation. METHODS: Children with the diagnosis of constipation according to Rome III criteria were included in the study. The children underwent transabdominal sonography for the evaluation of rectal diameter and rectal wall thickness. Ultrasonography was performed with a full bladder. Children without constipation who underwent abdominal sonography were assigned to the control group. RESULTS: The rectal diameter was larger in children with constipation than in children without constipation (31.72±9.63 mm vs 19.85±4.37 mm; P=0.001). The rectal wall was thinner in children with constipation than in children without constipation (1.75±0.33 mm vs 1.90±0.22 mm; P=0.032). There was no significant difference between boys and girls with constipation in terms of rectal diameter (31.02±8.57 mm 32.77±11.35 mm; P=0.63). CONCLUSION: Transabdominal rectal diameter measurement may be useful in the diagnosis of constipation.
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Yabunaka K, Nakagami G, Tabata K, Sugama J, Matsumoto M, Kido Y, Iuchi T, Sanada H. Constipation in the elderly in a Japanese long-term medical facility: An ultrasonographic investigation. Drug Discov Ther 2018; 12:233-238. [PMID: 30224595 DOI: 10.5582/ddt.2018.01033] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
This study aims to assess the fecal retention in elderly patients using colonic ultrasonography (US) in Japanese long-term care facility and determine the correlation between nutrition management methods and the fecal retention by US. This cross-sectional, single-center study was conducted in a long-term care facility in Japan. Patients with chronic constipation fulfilled the Rome III criteria for the diagnosis of functional constipation. US was performed on constipation patients with 4-day fecal retention before starting the standard management of constipation. After patients had defecated, nurses checked the outside of feces using King's Stool Chart and Bristol Stool Chart. All of 32 patients underwent the management of suppository laxative, the daily life independence level in grade C. In all cases, the King's Stool Chart did not detect > 200 g of fecal matter; the Bristol Stool Chart revealed type 5-7 in 56.2% of patients. The total parenteral nutrition and tube feeding did not completely detect type 1-2 in 0%. While the fecal retention groups comprised 15.6%, the non-fecal retention groups comprised 84.4%. The total parenteral nutrition did not completely detect the fecal retention in 0%. In the non-fecal retention groups, the King's Stool Chart indicated < 100 g in 81.8%, and the Bristol Stool Chart indicated type 5-7 in 100%. In conclusion, fecal properties of elderly constipation patients with the long-term parenteral nutrition should be assessed in follow-up examination by US, which is possible for personalized medical care by US, to avoid the administered regular management of constipation.
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Affiliation(s)
- Koichi Yabunaka
- Department of Imaging Nursing Science, Graduate School of Medicine, The University of Tokyo.,Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo
| | - Gojiro Nakagami
- Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo.,Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo
| | | | - Junko Sugama
- Institute for Frontier Science Initiative, Kanazawa University
| | - Masaru Matsumoto
- Department of Imaging Nursing Science, Graduate School of Medicine, The University of Tokyo.,Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo
| | | | - Terumi Iuchi
- Wellness Promotion Science Center, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University
| | - Hiromi Sanada
- Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo.,Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo
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12
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Measuring the Transrectal Diameter on Point-of-Care Ultrasound to Diagnose Constipation in Children. Pediatr Emerg Care 2018; 34:154-159. [PMID: 27299294 DOI: 10.1097/pec.0000000000000775] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES The aim of the study was to determine the test performance characteristics for point-of-care ultrasound in diagnosing constipation, through measuring the transrectal diameter (TRD). We sought to develop a sonographic numeric cutoff value for diagnosing constipation. Secondary objectives included whether certain patient characteristics would affect the TRD measurement and the accuracy of the TRD in comparison with abdominal radiographs. METHODS We conducted a prospective, cohort study of pediatric patients between the age of 4 and 17 years, presenting with abdominal pain to a pediatric emergency department. A point-of-care ultrasound was performed with a phased array transducer (5-1 MHz). In addition to a thorough history and physical examination, each patient was administered with the Rome III questionnaire, which served as the criterion standard for the diagnosis of constipation. Radiographs and enema treatments were performed at the discretion of the treating attending physician. When enemas were administered, a postenema TRD measurement was obtained. RESULTS Fifty subjects were "constipated" or "nonconstipated," as determined by the Rome III questionnaire. A TRD cutoff of 3.8 cm or greater correlated with the diagnoses of constipation (P < 0.001). Ultrasound-diagnosed constipation had a sensitivity of 86% (95% confidence interval, 69%-96%), specificity of 71% (95% CI, 53%-85%), negative predictive value of 0.87 (95% CI, 0.68-0.95), and positive predictive value of 0.70 (95% CI, 0.52-0.84). The TRD measurement was not affected by patient physical characteristics or bladder fullness. In 7 patients, an enema was administered. There was an overall mean (SD) decrease of 1.22 (1.62) cm; this difference was not statistically significant (P = 0.093). Abdominal radiographs were performed in 25 patients. When compared with abdominal radiographs, ultrasound had a higher specificity of 71% (95% CI, 53%-85%), but this difference was not statistically significant. Ultrasound performed similarly to abdominal radiographs with regard to sensitivity 86% (95% CI, 67%-95%), positive predictive value of 0.70 (95% CI, 0.52-0.84), and negative predictive value of 0.87 (0.68-0.95). In 22 of 25 patients who received radiographs, the ultrasound diagnosis was the same as the radiologist read of the radiographs. Potentially, 88% of radiographs could have been avoided in these patients. CONCLUSIONS In pediatric patients with abdominal pain, there is a strong correlation of an enlarged TRD with constipation. Our results suggest that point-of-care ultrasound is a useful adjunct for diagnosing constipation and has the potential to replace the use of abdominal radiographs.
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Hatori R, Tomomasa T, Ishige T, Tatsuki M, Arakawa H. Fecal retention in childhood: Evaluation on ultrasonography. Pediatr Int 2017; 59:462-466. [PMID: 27706882 DOI: 10.1111/ped.13185] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Revised: 09/09/2016] [Accepted: 09/30/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND To assess the usefulness of rectal diameter measurement on ultrasonography as a diagnostic tool for fecal retention in children. METHODS One hundred children (median age, 5.0 years), consisting of 80 with functional constipation and 20 without constipation, participated in the study. All patients underwent physical examination that included digital rectal examination. Forty-five children underwent ultrasonography in three differential planes: transection above the symphysis; under the ischial spine; and at the bladder neck. The measurement of the rectal diameter at the transection above the symphysis could most easily detect fecal retention and had the closest correlations with retention among the three planes. RESULTS Rectal diameter was wider at all measuring points (35.2 vs 20.9 mm above the symphysis, P < 0.0001; 35.7 vs 24.0 mm under the ischial spine, P < 0.0001; and 19.4 vs 8.7 mm at the bladder neck, P < 0.0001) in children with fecal retention than in those with no fecal retention. With regard to presence of constipation, children with fecal retention had a wider rectal diameter above the symphysis than those with no fecal retention (children with functional constipation, 35.3 vs 20.0 mm, P < 0.0001; children without constipation: 32.6 vs 14.6 mm, P = 0.0026). The cut-off for the rectal diameter measured above the symphysis to identify fecal retention was 27 mm, with high sensitivity and specificity (95.5% and 94.1%, respectively). CONCLUSION Ultrasound rectal diameter measurement can be used to detect fecal retention in children.
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Affiliation(s)
- Reiko Hatori
- Department of Pediatrics, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | | | - Takashi Ishige
- Department of Pediatrics, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Maiko Tatsuki
- Department of Pediatrics, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Hirokazu Arakawa
- Department of Pediatrics, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
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14
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Modin L, Dalby K, Walsted AM, Jakobsen M. Transabdominal ultrasound measurement of rectal diameter is dependent on time to defecation in constipated children. J Paediatr Child Health 2015; 51:875-80. [PMID: 25872799 DOI: 10.1111/jpc.12881] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/23/2015] [Indexed: 11/27/2022]
Abstract
AIM To study whether diurnal variations and time in relation to defecation has to be taken into account when measurements of rectal diameter are used to determine faecal impaction in constipated children. METHODS Repeated ultrasound measures of rectal diameter were performed in 28 children (14 constipated/14 healthy, aged between 4 and 12 years) every third hour during 24 h. After defecation, three additional scans were performed at 1-h intervals. RESULTS No diurnal variation in rectal diameter was found in the healthy group. In the constipated group, mean rectal diameter was significantly larger at 2 pm (P = 0.038) and 5 pm (P = 0.006). There were significant differences between rectal diameter in the healthy group and the constipated group at 2 pm (P = 0.016) and 5 pm (P = 0.027). When we omitted the rectal diameter of five constipated children who had their first bowel movement after 5 pm, there were no difference between groups (2 pm (P = 0.103)/5 pm (P = 0.644) ). Only in the constipated group, rectal diameter exceeded 3 cm without the patients feeling the urge to defecate. CONCLUSION We found no independent daily variation in either group without relation to defecation. There was a relation between defecation and changes in rectal diameter in both healthy children and constipated children during maintenance treatment.Asking for defecation signals before scanning should be considered a routine question, and a positive answer should cause postponement of the scan.
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Affiliation(s)
- Line Modin
- Department of Paediatrics, Hospital Lillebaelt, Kolding, Denmark.,Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Kasper Dalby
- Department of Paediatrics, Hospital Lillebaelt, Kolding, Denmark
| | | | - Marianne Jakobsen
- Department of Paediatrics, Hospital Lillebaelt, Kolding, Denmark.,Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
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Yabunaka K, Matsuo J, Hara A, Takii M, Nakagami G, Gotanda T, Nishimura G, Sanada H. Sonographic Visualization of Fecal Loading in Adults. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2015. [DOI: 10.1177/8756479314566045] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
The aim of this study was to compare ultrasonographic assessment of fecal loading in adults with that of computed tomography. Ultrasonography (US) was performed on 43 adult patients immediately after abdominal computed tomography images had identified fecal loading in their colons. In 18 of 43 patients (haustrations-visualized cases), fecal loading was detected as crescent-shaped acoustic shadows associated with haustrations behind the strong echoes off the colon wall. In the remaining 25 patients (haustrations-not-visualized cases), fecal loading was detected as attenuating echoes with multiple high echoic spots behind weak high echoes off the colon wall in 17 patients and similar to those seen in the haustrations-visualized cases but without haustrations in 8 patients. US can be used for qualitative assessment of fecal loading in the colon. This new technique is simple and noninvasive and can be used concomitantly with physical examination to assess severity of constipation.
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Affiliation(s)
- Koichi Yabunaka
- Department of Ultrasound, Katsuragi Hospital, Japan
- Department of Gerontological Nursing/Wound Care Management, the University of Tokyo, Tokyo, Japan
| | - Jyunko Matsuo
- Faculty of Nursing, Osaka Medical College, Osaka, Japan
| | - Akiko Hara
- Faculty of Nursing, Osaka Medical College, Osaka, Japan
| | | | - Gojiro Nakagami
- Department of Gerontological Nursing/Wound Care Management, the University of Tokyo, Tokyo, Japan
| | - Tatsuhiro Gotanda
- Department of Radiological Science, Junshin Gakuen University, Fukuoka, Japan
| | - Genichi Nishimura
- Department of Surgery, Japanese Red Cross Kanazawa Hospital, Ishikawa, Japan
| | - Hiromi Sanada
- Faculty of Nursing, Osaka Medical College, Osaka, Japan
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