Diagnosis and follow-up in constipated children: should we use ultrasound? ☆ Ayşe Karaman a, ⁎ , Selma Uysal Ramadan b , İbrahim Karaman a , Dilek Gökharman b , Derya Erdoğan a , Mahmut Kacar b , Yusuf Hakan Çavuşoğlu a ,Uğur Koşar b a Department of Pediatric Surgery, Dr Sami Ulus Children's Hospital, 06080 Ankara, Turkey b Department of Radiology, Ankara Training and Research Hospital, 06750 Ankara, Turkey Received 7 December 2009; revised 19 April 2010; accepted 4 May 2010 Key words: Constipation; Child; Rectum; Rome III criteria; Ultrasonography Abstract Purpose: We investigated the efficacy of ultrasound in determining megarectum and fecal load and the response to treatment in constipation and tried to specify objective criteria in this study. Methods: A total of 66 cases were queried and divided into 2 groups as constipated (n = 35; mean age, 6.8 ± 2.9 years) and control (n = 31; mean age, 8.4 ± 3.8 years) according to Rome III criteria. After the clinical evaluation, pelvic ultrasonography (US) was performed by 2 separate radiologists. The bladder capacity and the transverse rectal diameter were measured with a full bladder. Then the rectal diameter and rectal anterior wall thickness were measured, and the presence of fecal load in the rectum and sigmoid colon was recorded with an empty bladder. The examination and ultrasound were repeated after treatment for a month in these patients. Results: Comparison of the US measurements of the 2 radiologists performing the US tests did not show any interobserver difference (r = 0.981; P b .001). We therefore believe our results are objective and reproducible. We found a positive correlation between the rectal diameters and the age, height, weight, and bladder capacity. The posturination mean rectal diameter was thicker in the constipated group (3.02 ± 1.04 cm) than in the control group (1.98 ± 0.64 cm) (P b .001). The cutoff point of rectal diameter for a diagnosis of constipation was determined as 2.44 cm (71% sensitive; 76% specific; area under curve, 0.825; P b .001). The rectal anterior wall thickness and fecal load were higher in the constipated patients (P b .001). There was a significant decrease in the constipation score and fecal load after treatment for a month (P b .001), but the rectal diameter had not reached normal limits yet despite the decrease (2.71 ± 0.77 cm) (P N .05). ConclusionThe use of US helps in making a correct diagnosis and in the follow-up with objective criteria and also convinces the patient and the family that the treatment needs to be continued. © 2010 Elsevier Inc. All rights reserved. Constipation is frequently encountered in children and its incidence is estimated to be 1% to 30% in childhood [1]. The most common cause of constipation in childhood is an acquired behavior after an experience of painful and ☆ Presented at the 7th Balkan Congress of Radiology, November 18- 22, 2009, İstanbul, Turkey. ⁎ Corresponding author. Dr. Sami Ulus Children's Hospital, Babür Caddesi, No: 44, 06080, Altındağ, Ankara, Turkiye/Turkey. Fax: +90 3123170353. E-mail address: ayseuk@gmail.com (A. Karaman). www.elsevier.com/locate/jpedsurg 0022-3468/$ – see front matter © 2010 Elsevier Inc. All rights reserved. doi:10.1016/j.jpedsurg.2010.05.006 Journal of Pediatric Surgery (2010) 45, 1849–1855