Constipation abdominal x ray

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Eiman Ghaffarpasand, M.D. [2]

Overview

An abdominal X-ray may be helpful in the diagnosis of constipation. Findings on an X-ray suggestive of constipation is interpreted according to three scoring system, including Barr, Blethyn, and Leech systems. Barr scoring system is the first scoring method used to interpret abdominal X-ray suggestive of constipation. The total score of more than 10 was postulated as diagnosis of constipation. The revised scoring system of Blethyn (a simplified version of Barr scoring system) is based on the amount of remained feces in large bowel. The Blethyn scoring system consists of 4 grades of fecal retention in bowels. The most studies and organized scoring system for diagnosis of constipation is Leech method. The score of more than 8 is considered as constipation.

Abdominal X-ray

  • An abdominal X-ray may be helpful in the diagnosis of constipation. The most common method to diagnose constipation is using Sitzmarks®.
  • Findings on an X-ray suggestive of constipation in children is interpreted according to three scoring system, including Barr, Blethyn, and Leech systems.


Sitzmarks

  • Sitzmarks are radioopaque markers which are plastic beads or rings are been contained in a edible capsule.
  • There are 20-50 rings in each capsule. There are two methods of diagnosis:
  • On the day 5, more than 20% of markers remaining within bowels is diagnostic of delayed colonic transit.[1]



Constipation with Sitzmarks-Case courtesy of Dr Matt A. Morgan, via Radiopaedia.org[2]

Barr scoring system

  • Barr scoring system is the first scoring method used to interpret abdominal X-ray suggestive of constipation.
  • The main identifier in Barr system is stool retention severity in bowels seen on abdominal X-ray.
  • The total score of more than 10 was postulated as diagnosis of constipation.[3]
Scoring elements Scores
The quantity of stool in ascending colon 0-1-2 points
The quantity of stool in transverse colon 0-2-5 points
The quantity of stool in descending colon 0-3-4 points
The quantity of stool in rectum 0-2-5 points
The quality of the retained stool is expressed in scybala 0-1-2-3 points
The quality of the retained stool is expressed in granular feces 0-2-4-5 points

Blethyn scoring system

  • The revised scoring system of Blethyn (simplified version of Barr scoring system) is based on the amount of remained feces in large bowel.
  • The Blethyn scoring system consists of 4 grades of fecal retention in bowels.[4]
Scoring element Grade Constipation severity
Feces in rectum and caecum only 0 Normal
Feces in rectum and caecum and discontinuous elsewhere 1 Mild
Feces in rectum and caecum, continuous and affecting all segments 2 Moderate
Feces in rectum and caecum, continuous elsewhere and dilated colon and impacted rectum 3 Severe
Leech scoring areas-By Mikael Häggström and Nevit Dilmen, via Wikimedia Commons[5]

Leech scoring system

Scoring element Scores
No feces visible 0
Scanty feces visible 1
Mild fecal loading 2
Moderate fecal loading 3
Severe fecal loading 4
Severe fecal loading with bowel dilatation 5

Sensitivity and specificity

Author Year Scoring system Sensitivity (%) Specificity (%)
Barr[3] 1979 Barr 80 90
Leech[6] 1999 Leech 76 75
Benninga[7] 1995 Barr 60 43
Beckmann[8] 2001 Barr 77 35
Pensabene[9] 2010 Leech 57 74
Rezazadeh[10] 2014 Barr 83 79
Leech 92 80
Blethyn 79 92

References

  1. Kim ER, Rhee PL (2012). "How to interpret a functional or motility test - colon transit study". J Neurogastroenterol Motil. 18 (1): 94–9. doi:10.5056/jnm.2012.18.1.94. PMC 3271260. PMID 22323993.
  2. Radiopaedia.org. From the case <"https://radiopaedia.org/cases/37754">rID: 37754
  3. 3.0 3.1 Barr RG, Levine MD, Wilkinson RH, Mulvihill D (1979). "Chronic and occult stool retention: a clinical tool for its evaluation in school-aged children". Clin Pediatr (Phila). 18 (11): 674, 676, 677–9, passim. doi:10.1177/000992287901801103. PMID 498690.
  4. Blethyn AJ, Verrier Jones K, Newcombe R, Roberts GM, Jenkins HR (1995). "Radiological assessment of constipation". Arch. Dis. Child. 73 (6): 532–3. PMC 1511442. PMID 8546512.
  5. <CC BY-SA 3.0> <"https://commons.wikimedia.org/wiki/File%3ALeech_scoring_areas.jpg">
  6. 6.0 6.1 Leech SC, McHugh K, Sullivan PB (1999). "Evaluation of a method of assessing faecal loading on plain abdominal radiographs in children". Pediatr Radiol. 29 (4): 255–8. doi:10.1007/s002470050583. PMID 10199902.
  7. Benninga MA, Büller HA, Staalman CR, Gubler FM, Bossuyt PM, van der Plas RN, Taminiau JA (1995). "Defaecation disorders in children, colonic transit time versus the Barr-score". Eur. J. Pediatr. 154 (4): 277–84. PMID 7607277.
  8. Beckmann KR, Hennes H, Sty JR, Walsh-Kelly CM (2001). "Accuracy of clinical variables in the identification of radiographically proven constipation in children". WMJ. 100 (1): 33–6. PMID 11315444.
  9. Pensabene L, Buonomo C, Fishman L, Chitkara D, Nurko S (2010). "Lack of utility of abdominal x-rays in the evaluation of children with constipation: comparison of different scoring methods". J. Pediatr. Gastroenterol. Nutr. 51 (2): 155–9. doi:10.1097/MPG.0b013e3181cb4309. PMC 2910825. PMID 20453675.
  10. REZAZADEH, Afshin; JAVAHERIZADEH, Hazhir; CHAHARDAHCHERIK, Farzaneh; YAVARAHMADI, Mohammad Hossein; SADJADEI, Nooshin; TAHMASEBI, Morteza (2016). "RELIABILITY OF BARR, LEECH, AND BLETHYN SCORE IN USING OF PLAIN RADIOGRAPHY IN DETERMINING FECAL IMPACTION IN CHILDREN WITH AND WITHOUT CONSTIPATION". Arquivos de Gastroenterologia. 53 (3): 141–145. doi:10.1590/S0004-28032016000300004. ISSN 0004-2803.



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