Assessing fecal load with ultrasound in children with colorectal pathology: ReKiSo study
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In brief
In brief
This prospective study validates transabdominal rectal ultrasound as a radiation-free method to assess fecal load in children with colorectal conditions including Hirschsprung disease, anorectal malformations, and functional constipation. A 3 cm transverse rectal diameter cut-off effectively discriminates symptomatic from asymptomatic patients, offering clinicians an objective tool for monitoring bowel management programs.
- Transabdominal rectal ultrasound (TRU) provides radiation-free assessment of fecal load in pediatric colorectal pathology patients.
- Transverse rectal diameter (TRD) ≥3 cm discriminates between symptomatic constipation/overload and asymptomatic children across pathologies.
- TRU using the Klijn method effectively monitors bowel management in Hirschsprung disease, ARM, and functional constipation patients.
- Serial ultrasound measurements at 1/3/6 months enable objective tracking of bowel management efficacy without radiation exposure.
- TRD measurement with moderate bladder filling offers standardized, reproducible assessment for pediatric constipation diagnosis and follow-up.
Written by the GCMD Library team from the article.
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.