Purpose: Chronic idiopathic constipation (CIC) with soiling in children may r esult from slow colonic transit (SCT) or anorectal dysfunction and/or psychologi cal problems known as functional fecal retention (FFR). Ev...Purpose: Chronic idiopathic constipation (CIC) with soiling in children may r esult from slow colonic transit (SCT) or anorectal dysfunction and/or psychologi cal problems known as functional fecal retention (FFR). Evidence is accumulating that SCT and FFR need different treatments, but they are poorly distinguished b y solid marker studies. The authors used radionuclear transit scintigraphy to ca tegorize children with CIC as having either FFR or SCT. Methods: Children (N = 1 01) with CIC (and soiling) who were referred for further investigation after failure of standard treatments (diet, laxatives) received radiolabeled colloid orally, and scintillation images were collected at 0 to 2, 6, 24, 30 and 48 hours (total radiation dosage = 2 st andard x- rays). Radioactivity in 6 regions (precolonic, ascending, transverse, descending, rectosigmoid, and evacuated feces) was measured, and the median pos ition (geometric center) of radioactivity at each time was determined. Results: In children, meals normally reach the cecum at 6 hours and are evacuated in 30 t o 58 hours. Fifty patients had retention of radioactivity in the proximal colon at 48 hours, indicating SCT. Analysis of the images and the geometric center sho wed that passage through the ascending colon and transverse colon was delayed in SCT. In 24 patients, radioactivity was passed by 30 hours, indicating normal tr ansit or possible FFR. Twenty- two patients had retention in the rectum, indica ting definite FFR. Five studies were borderline. Conclusions: Radionuclear trans it scintigraphy is useful for categorizing patients with CIC as having either FF R or SCT, allowing for different treatments. Radionuclear transit scintigraphy p rovides more detail and greater sensitivity than solid marker studies in diagnos ing CIC. Radionuclear transit scintigraphy showed that half of our patients had SCT.展开更多
文摘Purpose: Chronic idiopathic constipation (CIC) with soiling in children may r esult from slow colonic transit (SCT) or anorectal dysfunction and/or psychologi cal problems known as functional fecal retention (FFR). Evidence is accumulating that SCT and FFR need different treatments, but they are poorly distinguished b y solid marker studies. The authors used radionuclear transit scintigraphy to ca tegorize children with CIC as having either FFR or SCT. Methods: Children (N = 1 01) with CIC (and soiling) who were referred for further investigation after failure of standard treatments (diet, laxatives) received radiolabeled colloid orally, and scintillation images were collected at 0 to 2, 6, 24, 30 and 48 hours (total radiation dosage = 2 st andard x- rays). Radioactivity in 6 regions (precolonic, ascending, transverse, descending, rectosigmoid, and evacuated feces) was measured, and the median pos ition (geometric center) of radioactivity at each time was determined. Results: In children, meals normally reach the cecum at 6 hours and are evacuated in 30 t o 58 hours. Fifty patients had retention of radioactivity in the proximal colon at 48 hours, indicating SCT. Analysis of the images and the geometric center sho wed that passage through the ascending colon and transverse colon was delayed in SCT. In 24 patients, radioactivity was passed by 30 hours, indicating normal tr ansit or possible FFR. Twenty- two patients had retention in the rectum, indica ting definite FFR. Five studies were borderline. Conclusions: Radionuclear trans it scintigraphy is useful for categorizing patients with CIC as having either FF R or SCT, allowing for different treatments. Radionuclear transit scintigraphy p rovides more detail and greater sensitivity than solid marker studies in diagnos ing CIC. Radionuclear transit scintigraphy showed that half of our patients had SCT.
