title: Rectal examination in children: digital versus transabdominal ultrasound.
abstract: OBJECTIVE
  We investigate 2 diagnostic tests to assess the rectal filling state.
  
  
  METHODS
  The rectal filling state was assessed with transabdominal ultrasound or with digital rectal examination by 2 independent investigators in children with urological problems before a scheduled diagnostic or surgical urological procedure. A dilated rectum filled with stool or large amounts of (usually) hard stool were both considered as a rectal fecal mass. All investigations were performed with the patient under general anesthesia. The kappa test was used to evaluate agreement between transabdominal ultrasound and digital rectal examination.
  
  
  RESULTS
  A total of 84 children (54 boys) with a median (p25-p75) age of 9.0 years (6.4-11) were eligible candidates. A rectal mass was found on transabdominal ultrasound and digital rectal examination in 32% and 41% of all children, respectively, with agreement between the 2 tests in 82.5%. Cohen's kappa showed good agreement of 0.62 (95% CI 0.45-0.79) between transabdominal ultrasound and digital rectal examination. The median (IQR) diameter of the rectum was 3.3 cm (2.8-3.9) in children with a full rectum, and 2.5 cm (1.8-2.8) and 2.0 cm (1.5-2.2) in patients with a half filled and empty rectum, respectively.
  
  
  CONCLUSIONS
  Transabdominal ultrasound is a noninvasive and reliable alternative to assess the rectal filling state, and might replace digital rectal examination in the evaluation of children with constipation.
authors.affiliation: Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands. r.e.burgers@amc.nl
authors.forename: Rosa
authors.initials: R
authors.lastname: Burgers
authors.forename: Tom P V M
authors.initials: TP
authors.lastname: de Jong
authors.forename: Marc A
authors.initials: MA
authors.lastname: Benninga
mesh_terms: D000293:Adolescent; D000768:Anesthesia, General; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D003248:Constipation / Q000175:diagnosis* / Q000000981:diagnostic imaging; D051517:Digital Rectal Examination; D005260:Female; D006801:Humans; D008297:Male; D012007:Rectum / Q000000981:diagnostic imaging*; D011795:Surveys and Questionnaires; D014463:Ultrasonography
keywords: FC; RE; US; child; constipation; diagnosis; digital rectal examination; functional constipation; ultrasound