Defekografia i wlew doodbytniczy w ocenie przyczyn zaparć przewlekłych i nietrzymania stolca u dzieci

Bibliogr. s. 26

Background: The aim of the study was to assess the role of radiographic examinations, i.e. barium enema and defecography, in the diagnosis of chronic disturbances in defecation in children. Materials/Methods: The study group of 117 children was divided into 2 groups: children with constipation (subgroup A: children with constipation only, subgroup B: children with constipation and fecal incontinence) and children with fecal incontinence. Defecography was performed in 62 patients, barium enema in 70 patients, and defecography with barium enema in 32 patients. Retrospectively, a group of 20 children with barium enema, but without constipation or incontinence, was analyzed. Results: We assessed the length and width of the colon, features of non-specific inflammatory processes, and competence of the ileocecal valve. No statistically significant differences in the occurrence of the above-mentioned symptoms were observed between these study groups. Anorectal angle, pelvic floor excursion (descent), paste evacuation, width of the anal canal, and morphology of the rectum were assessed in the defecographic examination. Statistically significant differences concerning pelvic floor excursion, paste evacuation, and anal canal width as well as the coexistence of an abnormal anorectal angle and paste evacuation were observed between children with obstruction and children with fecal incontinence. Conclusions: 1. Barium enema has little diagnostic value in chronic constipation in children. 2. The advantages of defecography are a) precise definition of the kind and severity of disturbances in pelvic floor function; this is essential for effective treatment, b) the simplicity of the investigation, and c) its cost effectiveness. 3. The disadvantages of defecography are a) equivocal interpretation of single abnormal parameters, b) patient age should be above 6 years due to the necessity of close cooperation during examination, and c) the use of ionizing radiation, making the examination one of the last in the chain of diagnostic methods.