Pediatric Constipation

Etiology: Usually encopresis (psychological), rarely due to anatomical cause (caudal regression syndrome, Hirschsprung disease)
Imaging AXR:
— Check sacrum for caudal regression
— Characterize amount of stool as mild or moderate or severe
— Use the word constipation in the report Impression
DDX:
Complications: Stercoral colitis is colitis caused by fecal impaction
Treatment: Bowel clean out from above with polyethylene glycol or from below with high osmolar water soluble enema
Clinical: Most common cause of abdominal pain in children

Radiology Cases of Constipation

AXR of constipation — AXR AP shows a marked amount of stool in the ascending colon that decreases somewhat in the transverse and descending colon but that massively distends the rectum to fill almost the entire pelvis.

AXR of constipation — AXR shows a massive amount of stool from the cecum to the rectum.

AXR of constipation — AXR shows a marked amount of stool from the cecum to the rectum.

AXR of small bowel obstruction due to constipation — AXR shows multiple extremely dilated loops of small bowel and no rectal gas.

CT of constipation causing bladder outlet obstruction — Coronal (left) and sagittal (right) images from a CT with IV and oral contrast of the abdomen shows a hugely distended bladder whose dome nearly touches the inferior margin of the liver. There is a marked amount of stool throughout the colon, especially in the rectum where a fecaloma is pinching off the bladder neck and urethra.

Radiology Cases of Stercoral Colitis Due to Constipation

CT of stercoral colitis — Axial CT with contrast of the abdomen (above) shows marked diffuse wall thickening and mucosal enhancement of the transverse colon. Wall thickening and mucosal enhancement is also present but less pronounced in the descending colon on the coronal CT (below left) and rectum (below right). The colon is filled with a marked amount of stool from the cecum to the rectum.