Abdominal X-ray in constipation in children
Projectional radiography ("X-ray") of the abdomen in children for signs of constipation:
There is substantial evidence that abdominal X-ray should not be used in the diagnosis of constipation in children having symptoms thereof. According to a guideline from the Netherlands in 2014, colonic transit time is indicated far down the management algorithm, after for example gastroenterologist evaluation and initial treatment.
The diameters of different segments of the large intestine can be compared to the width of lumbar vertebra 2 for more consistent reference ranges on abdominal x-rays.
Ratios of large intestinal segments compared to lumbar vertebra 2, as 75th percentile, meaning that 25% of children normally have a ratio higher than this.
For children, the degree of constipation may be scored by the Leech or the Barr systems:
- The Leech system assigns a score of 0 to 5 based on the amount of feces:
- 0: no visible feces
- 1: scanty feces visible
- 2: mild fecal loading
- 3: moderate fecal loading
- 4: severe fecal loading
- 5: severe fecal loading with bowel dilatation
- These score are assigned separately for the right colon, the left colon and the rectosigmoid colon, resulting in a maximum score of 15. A Leech score of 9 or greater is regarded as positive for constipation.
- The Barr system rates both the amount and consistency of the faeces, and assigns a score separately for the ascending colon, transverse colon, descending colon and rectum. Its maximum score is 22, and a score of 10 or greater is regarded as positive for constipation.
The colon normally contains air, but the small intestine usually only contains minimal air.
In case of lower gastrointestinal series, a rather arbitrary cutoff has been suggested that children with symptoms of constipation with a colonic transit time of over 100 hours are categorized as having slow-transit constipation, and a colonic transit time of less than 100 hours as normal- or delayed-transit constipation.
- Any colon dilation, and maximal diameter, preferably qualitatively such as "mild"/"moderate"/"severe" because of geometric magnification
- Amount of fecal loading.
- For a full list of contributors, see article Radlines:Authorship for details. . Creators of images are attributed at the image description pages, seen by clicking on the images. See
- Tabbers, M.M.; DiLorenzo, C.; Berger, M.Y.; Faure, C.; Langendam, M.W.; Nurko, S.; Staiano, A.; Vandenplas, Y.; et al. (2014). "Evaluation and Treatment of Functional Constipation in Infants and Children ". Journal of Pediatric Gastroenterology and Nutrition 58 (2): 265–281. doi:10.1097/MPG.0000000000000266. ISSN 0277-2116.
- Koppen, Ilan J. N.; Yacob, Desale; Di Lorenzo, Carlo; Saps, Miguel; Benninga, Marc A.; Cooper, Jennifer N.; Minneci, Peter C.; Deans, Katherine J.; et al. (2016). "Assessing colonic anatomy normal values based on air contrast enemas in children younger than 6 years ". Pediatric Radiology 47 (3): 306–312. doi:10.1007/s00247-016-3746-0. ISSN 0301-0449. Archived from the original. .
- Leech, Susan C.; McHugh, Kieran; Sullivan, P. B. (1999). "Evaluation of a method of assessing faecal loading on plain abdominal radiographs in children ". Pediatric Radiology 29 (4): 255–258. doi:10.1007/s002470050583. ISSN 0301-0449.
- G., Anthony; H., Kathleen (2012). The Role of Diagnostic Tests in Constipation in Children . doi:10.5772/29213.
- Dr Mike Cadogan. AXR Interpretation. lifeinthefastlane.com. Last updated May 24, 2016
- "Colonic transit time in constipated children: does pediatric slow-transit constipation exist? ". J. Pediatr. Gastroenterol. Nutr. 23 (3): 241–51. October 1996. PMID 8890073. Archived from the original. .