Constipation is extremely common in children with an estimated prevalence as high as 28%. The National Institute of Health defines constipation as the passage of hard, dry stool that is difficult or painful to eliminate, less than three times per week. We aim to demonstrate that the transverse rectal diameter may be quickly, easily and accurately measured in the pediatric emergency department to diagnose constipation and may serve as an alternative to plain radiograph which are not reliably associated with constipation, expose patients to radiation and may lengthen emergency department stays.
Methods:
Our experimental study design is an observational prospective descriptive pilot study. Patients ages 4-18 in the emergency department with a chief complaint of constipation or abdominal pain were provided a validated questionnaire based on Rome III criteria to assess for the presence of constipation. A measurement of the transverse rectal diameter with a cut off of >2.44cm was determined by ultrasound noting the bladder volume. If an enema is administered, a repeat ultrasound measurement will be made and the two values compared.
Results:
All patients who met the requirements for constipation in the validated questionnaire had on average a rectal diameter of 4.36 cm compared to those who did not meet the requirements had an average measurement of 1.61 cm.
Conclusion:
Our results demonstrate that obtaining a measurement of rectal diameter via transabdominal ultrasound is a reliable alternative diagnostic constipation without exposure to harmful radiation from radiographs.