ORIGINAL ARTICLE Gastrointestinal transit in children with chronic idiopathic constipation Jonathan R. Sutcliffe Æ Sebastian K. King Æ John M. Hutson Æ David J. Cook Æ Bridget R. Southwell Accepted: 17 April 2009 / Published online: 6 May 2009 Ó Springer-Verlag 2009 Abstract Chronic constipation in children is common and produces significant morbidity. Identification of the site of dysmotility in constipation may determine the cause and permit directed management. Scintigraphy differenti- ates constipated patients with anorectal hold-up from those with colonic slowing. Adults with colonic slowing dem- onstrate variation in the site of hold-up. However, in children with colonic slowing, variability in the site of hold-up has not been investigated. Purpose The current study aimed to characterise colonic transit patterns in 64 children with chronic idiopathic constipation. Methods Scintigraphic images were grouped visually by their transit patterns. Intra-observer variation was assessed. Scintigraphic data were analysed quantitatively. Results Visual analysis of scintigraphy studies demon- strated normal transit (11/64), anorectal hold-up (7/64) and slow colonic transit (46/64). Transit characteristics in the slow transit group demonstrated three possible subgroups: pancolonic slowing (28/46), discrete hold-up in the trans- verse colon (10/46) and abnormal small and large bowel transit (8/46). Kappa testing demonstrated consistent characterisation (k = 0.79). Statistical analysis of scinti- graphic data demonstrated highly significant differences from normal (P \ 0.001) in the subgroups. Conclusion Scintigraphy demonstrates three possible transit patterns in children with chronic constipation sec- ondary to slow colonic transit. Keywords Anorectal retention Á Colonic dysmotility Á Scintigraphy Á Slow transit constipation Á Transit study Introduction Constipation is common in all age groups, affecting a quarter of the population at any one time [1]. In children, constipation is responsible for 3% of referrals to paediatric clinics [2] and up to 25% of referrals to paediatric gas- troenterology clinics [3]. Symptoms become chronic in 1/3 of children and may persist into adult life [4, 5]. The site of faecal hold-up may be at the level of the anorectum, or more proximally in the colon. In adults identification of the site of hold-up may influence man- agement [6, 7] by allowing better targeting of investigation and therapy [8]. Identification of colonic dysmotility is a prognostic indicator in adults with constipation as symp- toms are frequently resistant to treatment [9]. Slow transit constipation (STC), is now recognised in childhood [10, 11]. There are strong indications that STC in children and adults are distinct entities; in adults, females are almost exclusively affected but in children, sex distribution is equal. In addition, the age of onset is com- monly around pregnancy or childbirth for adult women, J. R. Sutcliffe Á S. K. King Á J. M. Hutson Department of General Surgery, Royal Children’s Hospital, Melbourne, Australia S. K. King Á J. M. Hutson Á B. R. Southwell (&) Murdoch Childrens Research Institute, Royal Children’s Hospital, Parkville, Melbourne 3052, Australia e-mail: bridget.southwell@mcri.edu.au S. K. King Á J. M. Hutson Á B. R. Southwell Department of Paediatrics, University of Melbourne, Melbourne, Australia D. J. Cook Department of Medical Imaging, Royal Children’s Hospital, Melbourne, Australia 123 Pediatr Surg Int (2009) 25:465–472 DOI 10.1007/s00383-009-2374-2