Noviello Carmine, Nobile Stefano, Romano Mercedes, Mazzarini Alessandra, Papparella Alfonso, Cobellis Giovanni
Pediatric Surgery Unit, Salesi Children Hospital, Via Corridoni, 11, 60128, Ancona, Italy.
Department of Woman and Child Health and Public Health, Division of Neonatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, University Cattolica del Sacro Cuore, Rome, Italy.
Indian J Gastroenterol. 2020 Apr;39(2):147-152. doi: 10.1007/s12664-020-01034-x. Epub 2020 May 13.
Constipation is a common problem in children, and most of the time, the cause is defined as functional. Our hypothesis is that children with functional refractory constipation had anatomic alterations of the colon.
All children with chronic refractory constipation who visited our centre underwent accurate clinical examination, contrast enema (CE), anorectal manometry (ARM) and rectal suction biopsies (RSB). In case of functional constipation, three operators measured the size of the colon using radiograms and calculated the ratio based on the width of the second lumbar vertebra. The measurements carried out were compared with those reported in the literature on patients of the same age without constipation.
Over a period of 24 months, 69 patients with chronic refractory constipation, aged between 1 and 14 years, visited our department. A CE was performed on 67, and 2 were excluded because of anal stenosis. Sixty-five underwent anorectal manometry. Rectal suction biopsies were needed in 14 children, and 2 of them were found to have colonic aganglionosis. After a complete evaluation, 57 (82.61%) patients were diagnosed having functional constipation. By comparing the data of the patients with those of normal children reported by the other authors, we found that none of the measurements was statistically significant except for the rectosigmoid length: the mean value in one-year-old patients was 19.03 vs. 9.75, and in older children, it was 19.46 vs. 9.59.
Recognizing an anatomic anomaly in patients suffering from functional constipation is important for specific treatment, especially when the ratio (rectosigmoid length/L2) is higher than 15.
便秘是儿童常见问题，大多数情况下病因被定义为功能性的。我们的假设是功能性难治性便秘患儿存在结肠解剖结构改变。
所有前来我们中心就诊的慢性难治性便秘患儿均接受了精确的临床检查、结肠造影（CE）、肛门直肠测压（ARM）和直肠吸引活检（RSB）。对于功能性便秘患儿，三名操作人员使用X线片测量结肠大小，并根据第二腰椎宽度计算比值。将所进行的测量结果与文献中报道的同龄无便秘患者的测量结果进行比较。
在24个月的时间里，69名年龄在1至14岁之间的慢性难治性便秘患儿前来我科就诊。67名患儿进行了结肠造影，2名因肛门狭窄被排除。65名患儿接受了肛门直肠测压。14名患儿需要进行直肠吸引活检，其中2名被发现患有结肠神经节缺失。经过全面评估，57名（82.61%）患者被诊断为功能性便秘。通过将这些患者的数据与其他作者报道的正常儿童的数据进行比较，我们发现除直肠乙状结肠长度外，其他测量结果均无统计学意义：一岁患者的平均值为19.03对9.75，年龄较大儿童的平均值为19.46对9.59。
认识到功能性便秘患者的解剖异常对于特定治疗很重要，尤其是当比值（直肠乙状结肠长度/L2）高于15时。
