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The Plain Abdominal Roentgenogram in the Management of Encopresis

The Plain Abdominal Roentgenogram in the Management of Encopresis Abstract Objective: To determine whether fecal retention in encopretic children can be assessed objectively using the plain abdominal roentgenogram and whether roentgenographic evidence of fecal retention is associated with clinical findings on presentation in encopretic children. Design: Retrospective case studies. Setting: Two pediatric incontinence clinics. Participants: Sixty children (72% male), aged 4 to 18 years (mean, 8 years), who met Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition criteria for the diagnosis of encopresis. All had a plain abdominal roentgenogram obtained on presentation. Interventions: None. Results: Using a systematic assessment tool with good interrater reliability (k=0.65), 78% (47) of the children had fecal retention by roentgenographic criteria on presentation, while 22% (13) did not. Retentive encopretic children were less likely to have a history of difficult toilet training (P=.018) than nonretentive encopretic children. There was no association between fecal retention and several clinical factors, including historical features commonly attributed to fecal retention. Retentive encopretic children were no more likely to have a palpable abdominal mass than nonretentive encopretic children, but they were more likely to have excessive stool on rectal examination (P=.015). Using the plain abdominal roentgenogram as the gold standard, the rectal examination showed a positive predictive value of 84.8% and a negative predictive value of 50% in assessing fecal retention. Conclusions: Fecal retention in encopretic children can be assessed objectively from a plain abdominal roentgenogram. Most, but not all, encopretic children present with fecal retention. A positive rectal examination is strongly predictive of fecal retention, in which case a roentgenogram is not necessary to make that diagnosis. A negative rectal examination may not rule out fecal retention, in which case an abdominal roentgenogram may be useful to make that diagnosis.(Arch Pediatr Adolesc Med. 1995;149:623-627) References 1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition . Washington, DC: American Psychiatric Association; 1987. 2. Bellman M. Studies on encopresis . Acta Paediatr Scand . 1966;170( (suppl) ):1-137. 3. Rutter M. Helping Troubled Children . Harmonds-worth, England: Penguin Education; 1975. 4. Levine MD. Children with encopresis: a descriptive analysis . Pediatrics . 1975; 56:412-416. 5. Howe AC, Walker CE. Behavioral management of toilet training, enuresis and encopresis . Pediatr Clin North Am . 1992;39:413-432. 6. Nolan T, Debelle G, Oberklaid F, Coffey C. Randomized trial of laxatives in the treatment of childhood encopresis . Lancet . 1991;338:523-527.Crossref 7. Barr RG, Levine MD, Wilkinson RH, Mulvihill D. Chronic and occult stool retention: a clinical tool for its evaluation in school-aged children . Clin Pediatr . 1979;18:674-686.Crossref 8. Levine MD. Encopresis . In: Levine MD, Carey WB, Crocker AC, Gross RT, eds. Developmental-Behavioral Pediatrics . Philadelphia, Pa: WB Saunders Co; 1983: 586-595. 9. Rosner B. Fundamentals of Biostatistics . 3rd ed. Boston, Mass: PWS-Kent; 1990:456-458. 10. Schmitt BD, Mauro RD. Encopresis: should impactions be x-rayed? Contemp Pediatr . 1992:9-9. 11. Boon FFL, Singh NN. A model for the treatment of encopresis . Behav Modif . 1991;15:355-371.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Pediatrics & Adolescent Medicine American Medical Association

The Plain Abdominal Roentgenogram in the Management of Encopresis

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References (12)

Publisher
American Medical Association
Copyright
Copyright © 1995 American Medical Association. All Rights Reserved.
ISSN
1072-4710
eISSN
1538-3628
DOI
10.1001/archpedi.1995.02170190033006
Publisher site
See Article on Publisher Site

Abstract

Abstract Objective: To determine whether fecal retention in encopretic children can be assessed objectively using the plain abdominal roentgenogram and whether roentgenographic evidence of fecal retention is associated with clinical findings on presentation in encopretic children. Design: Retrospective case studies. Setting: Two pediatric incontinence clinics. Participants: Sixty children (72% male), aged 4 to 18 years (mean, 8 years), who met Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition criteria for the diagnosis of encopresis. All had a plain abdominal roentgenogram obtained on presentation. Interventions: None. Results: Using a systematic assessment tool with good interrater reliability (k=0.65), 78% (47) of the children had fecal retention by roentgenographic criteria on presentation, while 22% (13) did not. Retentive encopretic children were less likely to have a history of difficult toilet training (P=.018) than nonretentive encopretic children. There was no association between fecal retention and several clinical factors, including historical features commonly attributed to fecal retention. Retentive encopretic children were no more likely to have a palpable abdominal mass than nonretentive encopretic children, but they were more likely to have excessive stool on rectal examination (P=.015). Using the plain abdominal roentgenogram as the gold standard, the rectal examination showed a positive predictive value of 84.8% and a negative predictive value of 50% in assessing fecal retention. Conclusions: Fecal retention in encopretic children can be assessed objectively from a plain abdominal roentgenogram. Most, but not all, encopretic children present with fecal retention. A positive rectal examination is strongly predictive of fecal retention, in which case a roentgenogram is not necessary to make that diagnosis. A negative rectal examination may not rule out fecal retention, in which case an abdominal roentgenogram may be useful to make that diagnosis.(Arch Pediatr Adolesc Med. 1995;149:623-627) References 1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition . Washington, DC: American Psychiatric Association; 1987. 2. Bellman M. Studies on encopresis . Acta Paediatr Scand . 1966;170( (suppl) ):1-137. 3. Rutter M. Helping Troubled Children . Harmonds-worth, England: Penguin Education; 1975. 4. Levine MD. Children with encopresis: a descriptive analysis . Pediatrics . 1975; 56:412-416. 5. Howe AC, Walker CE. Behavioral management of toilet training, enuresis and encopresis . Pediatr Clin North Am . 1992;39:413-432. 6. Nolan T, Debelle G, Oberklaid F, Coffey C. Randomized trial of laxatives in the treatment of childhood encopresis . Lancet . 1991;338:523-527.Crossref 7. Barr RG, Levine MD, Wilkinson RH, Mulvihill D. Chronic and occult stool retention: a clinical tool for its evaluation in school-aged children . Clin Pediatr . 1979;18:674-686.Crossref 8. Levine MD. Encopresis . In: Levine MD, Carey WB, Crocker AC, Gross RT, eds. Developmental-Behavioral Pediatrics . Philadelphia, Pa: WB Saunders Co; 1983: 586-595. 9. Rosner B. Fundamentals of Biostatistics . 3rd ed. Boston, Mass: PWS-Kent; 1990:456-458. 10. Schmitt BD, Mauro RD. Encopresis: should impactions be x-rayed? Contemp Pediatr . 1992:9-9. 11. Boon FFL, Singh NN. A model for the treatment of encopresis . Behav Modif . 1991;15:355-371.Crossref

Journal

Archives of Pediatrics & Adolescent Medicine – American Medical Association

Published: Jun 1, 1995

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