{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T18:32:10Z","timestamp":1784313130450,"version":"3.55.0"},"reference-count":29,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2024,7,30]],"date-time":"2024-07-30T00:00:00Z","timestamp":1722297600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>Background: Constipation and outlet obstruction may persist after successful pull-through in Hirschsprung Disease (HD). The radiographic assessment of the faecal load is widely used but exposes the child to radiation. This study aims to evaluate whether the transrectal diameter (TRD) assessed with ultrasound correlates with symptoms of faecal load and whether the TRD normalises when symptoms disappear. Method: Children with HD after pullthrough and functional constipation presenting to our colorectal clinic between 4\/23 and 4\/24 were assessed for symptoms of constipation, smearing and outlet obstruction, as well as healthy controls. Ultrasound measurement of the TRD was conducted. Bowel management was initiated according to our institutional pathway using Peristeen\u00a9 irrigation after an orthograde disimpaction regime. Results: A total of 193 children underwent TRD assessment. Of 60 children with HD, 26 (43.3%) presented with obstructive symptoms, and 34 (56.7%) were asymptomatic. In asymptomatic patients with HD, the mean TRD of 2.26 cm (SD 0.61) was significantly (p &lt; 0.001) lower than in HD with symptoms, with a mean TRD of 3.35 cm (SD 1.03). Individuals without colorectal pathology had a mean TRD of 2.04 cm (SD 0.37), and children with functional constipation and symptoms showed a mean TRD of 4.36 cm (SD 1.32). The mean TRD after symptom resolution was 2.37 cm. Conclusions: Children with HD without obstructive symptoms have a TRD &lt; 3 cm, as do controls. The transrectal diameter allows the clinician to sonographically assess the faecal load in children with HD at the bedside without radiation. The TRD is useful for monitoring a bowel management program in children with HD.<\/jats:p>","DOI":"10.3390\/children11080921","type":"journal-article","created":{"date-parts":[[2024,8,1]],"date-time":"2024-08-01T12:38:20Z","timestamp":1722515900000},"page":"921","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Is the Transrectal Diameter (TRD) Suitable for Assessing Faecal Loads and Monitoring Bowel Management in Children with Hirschsprung Disease\u2014ReKiSo Study: Prospective Study"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3543-5974","authenticated-orcid":false,"given":"Judith","family":"Lindert","sequence":"first","affiliation":[{"name":"Department of Paediatric Surgery, University Hospital Rostock, Ernst-Heydemann Str. 8, 18057 Rostock, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-2367-6678","authenticated-orcid":false,"given":"Daniel","family":"Erkel","sequence":"additional","affiliation":[{"name":"Department of Paediatric Surgery, University Hospital Rostock, Ernst-Heydemann Str. 8, 18057 Rostock, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-9435-433X","authenticated-orcid":false,"given":"Felix","family":"Schulze","sequence":"additional","affiliation":[{"name":"Department of Paediatric Surgery, University Hospital Rostock, Ernst-Heydemann Str. 8, 18057 Rostock, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-6260-7830","authenticated-orcid":false,"given":"Meike","family":"Hofer","sequence":"additional","affiliation":[{"name":"Department of Paediatric Surgery, University Hospital Rostock, Ernst-Heydemann Str. 8, 18057 Rostock, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edyta","family":"Rzepka","sequence":"additional","affiliation":[{"name":"Department of Paediatric Surgery, University Hospital Rostock, Ernst-Heydemann Str. 8, 18057 Rostock, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefanie","family":"M\u00e4rzheuser","sequence":"additional","affiliation":[{"name":"Department of Paediatric Surgery, University Hospital Rostock, Ernst-Heydemann Str. 8, 18057 Rostock, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,7,30]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"336","DOI":"10.1053\/j.sempedsurg.2012.07.008","article-title":"Long-term outcomes of Hirschsprung\u2019s disease","volume":"21","author":"Rintala","year":"2012","journal-title":"Semin. Pediatr. Surg."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"164","DOI":"10.1186\/s13023-020-01362-3","article-title":"ERNICA guidelines for the management of rectosigmoid Hirschsprung\u2019s disease","volume":"15","author":"Kyrklund","year":"2020","journal-title":"Orphanet J. Rare Dis."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"902","DOI":"10.1016\/j.jpedsurg.2022.05.006","article-title":"Impact of rectal dissection technique on primary-school-age outcomes for a British and Irish cohort of children with Hirschsprung disease","volume":"57","author":"Allin","year":"2022","journal-title":"J. Pediatr. Surg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1502","DOI":"10.1016\/j.jpedsurg.2021.01.043","article-title":"Long-term surgical and patient-reported outcomes of Hirschsprung Disease","volume":"56","author":"Davidson","year":"2021","journal-title":"J. Pediatr. Surg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"348","DOI":"10.1097\/MPG.0000000000003355","article-title":"Functional Outcomes after Surgery for Total Colonic, Long-Segment, versus Rectosigmoid Segment Hirschsprung Disease","volume":"74","author":"Verkuijl","year":"2022","journal-title":"J. Pediatr. Gastroenterol. Nutr."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1007\/s11894-021-00819-0","article-title":"Evaluation and Management of Persistent Problems After Surgery for Hirschsprung Disease in a Child","volume":"23","author":"Ahmad","year":"2021","journal-title":"Curr. Gastroenterol. Rep."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"344","DOI":"10.1053\/j.sempedsurg.2012.07.009","article-title":"The Hirschsprungs patient who is soiling after what was considered a \u201csuccessful\u201d pull-through","volume":"21","author":"Levitt","year":"2012","journal-title":"Semin. Pediatr. Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1136\/archdischild-2015-309140","article-title":"How to use a plain abdominal radiograph in children with functional defecation disorders","volume":"101","author":"Benninga","year":"2016","journal-title":"Arch. Dis. Child. Educ. Pract. Ed."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1278","DOI":"10.1016\/j.jpedsurg.2009.02.047","article-title":"Treatment of fecal incontinence with a comprehensive bowel management program","volume":"44","author":"Bischoff","year":"2009","journal-title":"J. Pediatr. Surg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1007\/s00383-023-05508-9","article-title":"Radiologically supervised bowel management program outcome in patients with chronic idiopathic constipation","volume":"39","author":"Bischoff","year":"2023","journal-title":"Pediatr. Surg. Int."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"224","DOI":"10.1007\/s00247-005-0065-2","article-title":"Systematic assessment of constipation on plain abdominal radiographs in children","volume":"36","author":"Graafmans","year":"2006","journal-title":"Pediatr. Radiol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"674","DOI":"10.1177\/000992287901801103","article-title":"Chronic and occult stool retention: A clinical tool for its evaluation in school-aged children","volume":"18","author":"Barr","year":"1979","journal-title":"Clin. Pediatr."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"532","DOI":"10.1136\/adc.73.6.532","article-title":"Radiological assessment of constipation","volume":"73","author":"Blethyn","year":"1995","journal-title":"Arch. Dis. Child."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"255","DOI":"10.1007\/s002470050583","article-title":"Evaluation of a method of assessing faecal loading on plain abdominal radiographs in children","volume":"29","author":"Leech","year":"1999","journal-title":"Pediatr. Radiol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"236","DOI":"10.1007\/s00383-023-05513-y","article-title":"Standardization of radiograph readings during bowel management week","volume":"39","author":"Bischoff","year":"2023","journal-title":"Pediatr. Surg. Int."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1689","DOI":"10.1016\/j.jpedsurg.2021.04.029","article-title":"One-year impact of a bowel management program in treating fecal incontinence in patients with anorectal malformations","volume":"56","author":"Wood","year":"2021","journal-title":"J. Pediatr. Surg."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1016\/j.jpeds.2011.12.045","article-title":"Value of abdominal radiography, colonic transit time, and rectal ultrasound scanning in the diagnosis of idiopathic constipation in children: A systematic review","volume":"161","author":"Berger","year":"2012","journal-title":"J. Pediatr."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"154","DOI":"10.1097\/PEC.0000000000000775","article-title":"Measuring the Transrectal Diameter on Point-of-Care Ultrasound to Diagnose Constipation in Children","volume":"34","author":"Doniger","year":"2018","journal-title":"Pediatr. Emerg. Care"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1590\/s0004-2803.201900000-19","article-title":"Ultrasonography in determining the rectal diameter and rectal wall thickness in children with and without constipation: A case-control study","volume":"56","author":"Momeni","year":"2019","journal-title":"Arq. Gastroenterol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1121","DOI":"10.1007\/s00383-010-2687-1","article-title":"Hydrocolonic sonography: A helpful diagnostic tool to implement effective bowel management","volume":"26","author":"Schmidt","year":"2010","journal-title":"Pediatr. Surg. Int."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"823","DOI":"10.1016\/S0022-3468(97)90628-X","article-title":"Do children with repaired low anorectal malformations have normal bowel function?","volume":"32","author":"Rintala","year":"1997","journal-title":"J. Pediatr. Surg."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1","DOI":"10.5223\/pghn.2017.20.1.1","article-title":"The New Rome IV Criteria for Functional Gastrointestinal Disorders in Infants and Toddlers","volume":"20","author":"Zeevenhooven","year":"2017","journal-title":"Pediatr. Gastroenterol. Hepatol. Nutr."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1986","DOI":"10.1097\/01.ju.0000142686.09532.46","article-title":"The diameter of the rectum on ultrasonography as a diagnostic tool for constipation in children with dysfunctional voiding","volume":"172","author":"Klijn","year":"2004","journal-title":"J. Urol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"202","DOI":"10.1007\/s00383-024-05771-4","article-title":"Assessing fecal load with ultrasound in children with colorectal pathology: ReKiSo study","volume":"40","author":"Erkel","year":"2024","journal-title":"Pediatr. Surg. Int."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"343","DOI":"10.1097\/MPG.0000000000001483","article-title":"Consensus Review of Best Practice of Transanal Irrigation in Children","volume":"64","author":"Mosiello","year":"2017","journal-title":"J. Pediatr. Gastroenterol. Nutr."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1099","DOI":"10.1007\/s00383-011-2950-0","article-title":"A successful treatment strategy in infants and adolescents with anorectal malformation and incontinence with combined hydrocolonic ultrasound and bowel management","volume":"27","author":"Backhaus","year":"2011","journal-title":"Pediatr. Surg. Int."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"186","DOI":"10.1055\/s-0034-1544050","article-title":"Improvements in Incontinence with Self-Management in Patients with Anorectal Malformations","volume":"26","author":"Karsten","year":"2016","journal-title":"Eur. J. Pediatr. Surg."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1729","DOI":"10.1007\/s00383-022-05214-y","article-title":"The success rate of antegrade enemas for the management of idiopathic constipation","volume":"38","author":"Reppucci","year":"2022","journal-title":"Pediatr. Surg. Int."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Lindert, J., Schulze, F., and M\u00e4rzheuser, S. (2024). Bowel Management in Hirschsprung Disease-Pre-, Peri- and Postoperative Care for Primary Pull-Through. 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