Signs and symptoms of slow-transit constipation versus functional retention.
OBJECTIVE
Slow-transit constipation (STC) has been described recently in children. This retrospective study correlated symptoms, signs, transit times, and immunohistochemistry to determine the diagnostic differences between STC and functional fecal retention (FFR).


METHODS
One hundred eighty children with intractable constipation underwent clinical assessment, nuclear transit study (NTS), with or without laparoscopic colonic muscle biopsy. Patients were divided by NTS into those with STC and those with FFR. Parents completed questionnaires on presenting symptoms.


RESULTS
In 161 patients with STC and 19 with FFR, there were no differences in gender, gestation, or timing of symptom onset. Over 20% had the first meconium delayed more than 24 hours after birth even in FFR (4 of 19). Bloating and soiling were more common in STC. There were no differences between patients with STC but different histology on biopsy. More STC patients had soft stools (39%) than FFR (16%), and a lower stool frequency of less than once a week (STC 26% compared with 11% FFR). FFR was managed more often with medication or diet alone (53%) compared with STC (29%), where enemas, lavage, or surgery were more common.


CONCLUSIONS
Children with STC showed similar symptoms and signs to those with FFR, but more had bloating and soiling, softer stools, and longer intervals between bowel actions. Delayed meconium stool beyond 24 hours after birth was common in both groups. Diagnosis of STC or FFR required NTS and was not possible on symptoms alone.
Shin
Yeon Myung
YM
Department of Surgery, Kosin University, Kosin, Korea.
Southwell
Bridget R
BR
Stanton
Michael P
MP
Hutson
John M
JM
D001706:Biopsy; D002675:Child, Preschool; D002908:Chronic Disease; D003106:Colon / Q000473:pathology; D003248:Constipation / Q000175:diagnosis*; D005244:Fecal Impaction / Q000175:diagnosis; D005772:Gastrointestinal Transit; D006801:Humans; D007223:Infant; D012189:Retrospective Studies