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Pediatric Radiology
Published in: Pediatric Radiology 2/2015

01-02-2015 | Original Article

The value of fluoroscopic defecography in the diagnostic and therapeutic management of defecation disorders in children

Authors: Suzanne M. Mugie, D. Gregory Bates, Jaya B. Punati, Marc A. Benninga, Carlo Di Lorenzo, Hayat M. Mousa

Published in: Pediatric Radiology | Issue 2/2015

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Abstract

Background

Defecography is a study to assess anorectal function during evacuation.

Objective

To investigate the value of fluoroscopic defecography in directing diagnostic and therapeutic management in children with defecation disorders.

Materials and methods

We reviewed all fluoroscopic defecography studies performed (2003–2009) in children with defecation problems and normal anorectal motility studies. Results were classified into three groups: (1) normal pelvic floor function; (2) pelvic floor dyssynergia, including incomplete relaxation of pelvic musculature, inconsistent change in anorectal angle and incomplete voluntary evacuation; (3) structural abnormality, including excessive pelvic floor descent with an intra-rectal intussusception, rectocele or rectal prolapse.

Results

We included 18 patients (13 boys, median age 9.1 years). Indication for fluoroscopic defecography was chronic constipation in 56%, fecal incontinence in 22% and rectal prolapse in 22%. Defecography showed pelvic floor dyssynergia in 9 children (50%), a structural abnormality in 4 (22%) and normal pelvic floor function in 5 (28%). In 12 children (67%) the outcome of fluoroscopic defecography directly influenced therapeutic management. After defecography 4 children (22%) were referred for anorectal biofeedback treatment, 4 children (22%) for surgery, 2 children (11%) for additional MR defecography, and 1 child to the psychology department, and medication was changed in 1 child. In 6 children (33%) the result did not change the management. In 9 children (75%) the change of management was successful.

Conclusions

Fluoroscopic defecography can be a useful tool in understanding the pathophysiology and it may provide information that impacts management of children with refractory defecation disorders.
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Metadata
Title
The value of fluoroscopic defecography in the diagnostic and therapeutic management of defecation disorders in children
Authors
Suzanne M. Mugie
D. Gregory Bates
Jaya B. Punati
Marc A. Benninga
Carlo Di Lorenzo
Hayat M. Mousa
Publication date
01-02-2015
Publisher
Springer Berlin Heidelberg
Published in
Pediatric Radiology / Issue 2/2015
Print ISSN: 0301-0449
Electronic ISSN: 1432-1998
DOI
https://doi.org/10.1007/s00247-014-3137-3

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