{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,11]],"date-time":"2026-07-11T05:12:17Z","timestamp":1783746737621,"version":"3.55.0"},"reference-count":41,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T00:00:00Z","timestamp":1782950400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diseases"],"abstract":"<jats:p>Background: Constipation in children often presents with non-specific symptoms, which can complicate its recognition in the pediatric emergency department (PED). Aim: This study aimed to characterize the clinical presentations, diagnostic context and testing patterns of children discharged with constipation from a tertiary pediatric emergency center. Methods: A retrospective analysis of medical records of patients under 18 years of age was conducted for patients who presented to the PED of a tertiary hospital in northern Poland from 2021\u20132024 and were ultimately discharged as K59.0 ICD-10 code (constipation). Demographic data, symptoms reported upon admission, and laboratory and imaging tests performed were collected and reviewed. Results: PED visits discharged with ICD-10 code K59.0 accounted for 2.97% of all 34,278 PED visits during study period. Among 1017 patients discharged with ICD-10 code K59.0, only 26.5% reported constipation as their main complaint. The most common complaints were abdominal pain (61.6%), vomiting (14.4%), and urinary symptoms (4.9%). Commonly suspected initial diagnoses were urinary tract infections or acute appendicitis. More complete documentation of constipation-related symptoms showed an exploratory association with less intensive diagnostic testing. Conclusions: Constipation should be routinely considered in children presenting to the PED with abdominal pain, vomiting, urinary symptoms, or rectal bleeding, even when bowel problems are not the main complaint. Structured history taking supported by simple diagnostic tools could help standardize assessment and support patient selection for further testing, although prospective studies are needed to determine clinical outcomes.<\/jats:p>","DOI":"10.3390\/diseases14070239","type":"journal-article","created":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T15:52:24Z","timestamp":1783007544000},"page":"239","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Constipation in the Pediatric Emergency Department: Clinical Presentations, Diagnostic Context and Testing Patterns"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2166-7018","authenticated-orcid":false,"given":"Julia","family":"Leszkowicz","sequence":"first","affiliation":[{"name":"Department of Paediatrics, Gastroenterology, Allergology & Paediatric Nutrition, Medical University of Gda\u0144sk, Nowe Ogrody 1\/6, 80-803 Gda\u0144sk, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-5207-4613","authenticated-orcid":false,"given":"Kinga","family":"Mia\u015bkiewicz","sequence":"additional","affiliation":[{"name":"Department of Paediatrics, Gastroenterology, Allergology & Paediatric Nutrition, Medical University of Gda\u0144sk, Nowe Ogrody 1\/6, 80-803 Gda\u0144sk, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcin","family":"Wieczorek","sequence":"additional","affiliation":[{"name":"Copernicus Hospital, Nowe Ogrody 1\/6, 80-803 Gda\u0144sk, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Magdalena","family":"Dettlaff-Dunowska","sequence":"additional","affiliation":[{"name":"Department of Paediatrics, Gastroenterology, Allergology & Paediatric Nutrition, Medical University of Gda\u0144sk, Nowe Ogrody 1\/6, 80-803 Gda\u0144sk, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5992-4414","authenticated-orcid":false,"given":"Agnieszka","family":"Szlagatys-Sidorkiewicz","sequence":"additional","affiliation":[{"name":"Department of Paediatrics, Gastroenterology, Allergology & Paediatric Nutrition, Medical University of Gda\u0144sk, Nowe Ogrody 1\/6, 80-803 Gda\u0144sk, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,2]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1016\/j.jpeds.2018.02.029","article-title":"Prevalence of Functional Defecation Disorders in Children: A Systematic Review and Meta-Analysis","volume":"198","author":"Koppen","year":"2018","journal-title":"J. Pediatr."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"359","DOI":"10.1016\/j.jpeds.2004.10.046","article-title":"Prevalence, symptoms and outcome of constipation in infants and toddlers","volume":"146","year":"2005","journal-title":"J. Pediatr."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"258","DOI":"10.1097\/MPG.0000000000000266","article-title":"Evaluation and Treatment of Functional Constipation in Infants and Children: Evidence-Based Recommendations from ESPGHAN and NASPGHAN","volume":"58","author":"Tabbers","year":"2014","journal-title":"J. Pediatr. Gastroenterol. Nutr."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1080924","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_5","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1097\/01.MPG.0000155367.44628.21","article-title":"Chronic Abdominal Pain in Children: A Clinical Report of the American Academy of Pediatrics and the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition","volume":"40","author":"Colletti","year":"2005","journal-title":"J. Pediatr. Gastroenterol. Nutr."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"280","DOI":"10.1016\/j.ajem.2025.10.012","article-title":"ConstiPatED: Evaluation in the pediatric ED\u2014Practice pattern and trends amongst provider types","volume":"99","author":"Krishnaprasadh","year":"2026","journal-title":"Am. J. Emerg. Med."},{"key":"ref_7","unstructured":"(2026, June 21). Ludno\u015b\u0107. Stan i Struktura Oraz Ruch Naturalny w Przekroju Terytorialnym w 2024 r. (Stan w Dniu 31.12.2024), Available online: https:\/\/stat.gov.pl\/obszary-tematyczne\/ludnosc\/ludnosc\/ludnosc-stan-i-struktura-oraz-ruch-naturalny-w-przekroju-terytorialnym-w-2025-r-stan-w-dniu-31-grudnia,6,40.html."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1016\/j.ajem.2008.11.016","article-title":"Incidence, clinical presentation, and management of constipation in a pediatric ED","volume":"28","author":"Diamanti","year":"2010","journal-title":"Am. J. Emerg. Med."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1093\/pch\/pxx041","article-title":"Constipation and paediatric emergency department utilization","volume":"22","author":"Nutter","year":"2017","journal-title":"Paediatr. Child Health"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"823","DOI":"10.1136\/pgmj.2006.049551","article-title":"Factors contributing to inappropriate ordering of tests in an academic medical department and the effect of an educational feedback strategy","volume":"82","author":"Miyakis","year":"2006","journal-title":"Postgrad. Med. J."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"e116","DOI":"10.1097\/PEC.0000000000001637","article-title":"Practice Pattern Variation in Test Ordering for Low-Acuity Pediatric Emergency Department Patients","volume":"37","author":"Doctor","year":"2021","journal-title":"Pediatr. Emerg. Care"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"312","DOI":"10.1080\/08998280.2023.2288788","article-title":"Lab testing overload: A comprehensive analysis of overutilization in hospital-based settings","volume":"37","author":"Shaik","year":"2024","journal-title":"Bayl. Univ. Med. Cent. Proc."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1326","DOI":"10.1111\/jep.13867","article-title":"Diagnostic testing in children: A qualitative study of pediatricians\u2019 considerations","volume":"29","author":"Ropers","year":"2023","journal-title":"J. Eval. Clin. Pract."},{"key":"ref_14","unstructured":"McInerny, T.K., Adam, H.M., Campbell, D.E., Kamart, D.M., Baum, R., and Kelleher, K.J. (2016). Abdominal Pain (Chapter 125). American Academy of Pediatrics Textbook of Pediatric Care, American Academy of Pediatrics."},{"key":"ref_15","first-page":"e2021341","article-title":"The impact of constipation on pediatric emergency department: A retrospective analysis of the diagnosis and management","volume":"92","author":"Gatto","year":"2022","journal-title":"Acta Biomed. Atenei Parm."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"e24851","DOI":"10.2196\/24851","article-title":"Understanding Parents\u2019 Experiences When Caring for a Child with Functional Constipation: Interpretive Description Study","volume":"4","author":"Thompson","year":"2021","journal-title":"JMIR Pediatr. Parent."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1007\/s00431-018-3243-6","article-title":"The problem of defecation disorders in children is underestimated and easily goes unrecognized: A cross-sectional study","volume":"178","author":"Timmerman","year":"2019","journal-title":"Eur. J. Pediatr."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"211","DOI":"10.1053\/j.gastro.2012.10.029","article-title":"American Gastroenterological Association Medical Position Statement on Constipation","volume":"144","author":"Bharucha","year":"2013","journal-title":"Gastroenterology"},{"key":"ref_19","unstructured":"Waseem, M., and Wang, C.F. (2026, May 12). Pediatric Appendicitis, StatPearls, Available online: http:\/\/www.ncbi.nlm.nih.gov\/books\/NBK441864\/."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1016\/j.jpedsurg.2023.10.028","article-title":"Diagnostic Ultrasound for Acute Appendicitis: The Gold Standard","volume":"59","author":"Roberts","year":"2023","journal-title":"J. Pediatr. Surg."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"2227","DOI":"10.1007\/s00247-024-06083-4","article-title":"Accuracy of transabdominal ultrasound to diagnose functional constipation and fecal impaction in children: A systematic review and meta-analysis","volume":"54","author":"Vos","year":"2024","journal-title":"Pediatr. Radiol."},{"key":"ref_22","unstructured":"Beach, E.C., and De Jesus, O. (2026, May 12). Ileus, StatPearls, Available online: http:\/\/www.ncbi.nlm.nih.gov\/books\/NBK558937\/."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1016\/j.rcl.2021.08.006","article-title":"Neonatal and Pediatric Bowel Obstruction","volume":"60","author":"Hull","year":"2022","journal-title":"Radiol. Clin. N. Am."},{"key":"ref_24","unstructured":"Villanueva Herrero, J.A., Abdussalam, A., and Kasi, A. (2026, May 12). Rectal Exam, StatPearls, Available online: http:\/\/www.ncbi.nlm.nih.gov\/books\/NBK537356\/."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1328","DOI":"10.3748\/wjg.v23.i8.1328","article-title":"Pediatric gastrointestinal bleeding: Perspectives from the Italian Society of Pediatric Gastroenterology","volume":"23","author":"Romano","year":"2017","journal-title":"World J. Gastroenterol."},{"key":"ref_26","first-page":"278","article-title":"Urinary Tract Infections in Young Children and Infants: Common Questions and Answers","volume":"102","author":"Veauthier","year":"2020","journal-title":"Am. Fam. Physician"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"513","DOI":"10.1007\/s00345-025-05886-w","article-title":"Acute urinary retention in children: A systematic review and meta-analysis","volume":"43","author":"Ahmed","year":"2025","journal-title":"World J. Urol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"e842.e1","DOI":"10.1016\/j.jpurol.2020.08.014","article-title":"Acute urinary retention in children","volume":"16","author":"Schmidt","year":"2020","journal-title":"J. Pediatr. Urol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"291","DOI":"10.1038\/nrgastro.2018.7","article-title":"Advances in the diagnosis and classification of gastric and intestinal motility disorders","volume":"15","author":"Keller","year":"2018","journal-title":"Nat. Rev. Gastroenterol. Hepatol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"680","DOI":"10.1097\/PEC.0000000000001206","article-title":"Understanding the Constipation Conundrum: Predictors of Obtaining an Abdominal Radiograph During the Emergency Department Evaluation of Pediatric Constipation","volume":"35","author":"MacGeorge","year":"2019","journal-title":"Pediatr. Emerg. Care"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"109590","DOI":"10.5409\/wjcp.v14.i4.109590","article-title":"Occult constipation in children: An unaddressed problem of our day-to-day practice","volume":"14","author":"Benzamin","year":"2025","journal-title":"World J. Clin. Pediatr."},{"key":"ref_32","first-page":"677","article-title":"Occult constipation: A common cause of recurrent abdominal pain in childhood","volume":"6","author":"Mimouni","year":"2004","journal-title":"Isr. Med. Assoc. J."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1304","DOI":"10.1016\/j.arcped.2007.07.008","article-title":"Une pr\u00e9valence excessive du diagnostic de constipation chez les enfants consultant pour douleurs abdominales aux urgences: Un exemple d\u2019\u00e9valuation des pratiques","volume":"14","author":"Chartier","year":"2007","journal-title":"Arch. P\u00e9diatrie"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1490","DOI":"10.1016\/j.ajem.2017.04.060","article-title":"Diagnostic approach to constipation impacts pediatric emergency department disposition","volume":"35","author":"Chumpitazi","year":"2017","journal-title":"Am. J. Emerg. Med."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1367","DOI":"10.1053\/j.gastro.2026.01.036","article-title":"Lower and Biliary Disorders of Gut\u2013Brain Interaction: Child and Adolescent","volume":"170","author":"Lorenzo","year":"2026","journal-title":"Gastroenterology"},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Hasosah, M., Haleem, A., Jacobson, K., Alshemmeri, B., Alenazi, A., Badei, A.A., and Massoud, P. (2022). Knowledge and practice of pediatricians regarding childhood constipation in the Arab world: Results from a multicenter survey. BMC Pediatr., 22.","DOI":"10.1186\/s12887-022-03536-3"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"e183","DOI":"10.3346\/jkms.2019.34.e183","article-title":"Nationwide Survey for Application of ROME IV Criteria and Clinical Practice for Functional Constipation in Children","volume":"34","author":"Jang","year":"2019","journal-title":"J. Korean Med. Sci."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"677","DOI":"10.1111\/j.1651-2227.2012.02632.x","article-title":"The care of constipated children in primary care in different countries","volume":"101","author":"Burgers","year":"2012","journal-title":"Acta Paediatr."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"944","DOI":"10.1111\/ped.14239","article-title":"Pediatricians\u2019 perceptions and practice of the management of constipation in Thailand","volume":"62","author":"Wiriyachai","year":"2020","journal-title":"Pediatr. Int."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1381","DOI":"10.14309\/ajg.0000000000003218","article-title":"Comparison of the Bristol Stool Scale and Modified Version for Children: Use by Providers vs Children","volume":"120","author":"Orozco","year":"2024","journal-title":"Am. J. Gastroenterol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"521","DOI":"10.1016\/j.jpeds.2008.10.010","article-title":"Infant stool form scale: Development and results","volume":"154","author":"Bekkali","year":"2009","journal-title":"J. Pediatr."}],"container-title":["Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2079-9721\/14\/7\/239\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,11]],"date-time":"2026-07-11T04:23:19Z","timestamp":1783743799000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2079-9721\/14\/7\/239"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,2]]},"references-count":41,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2026,7]]}},"alternative-id":["diseases14070239"],"URL":"https:\/\/doi.org\/10.3390\/diseases14070239","relation":{},"ISSN":["2079-9721"],"issn-type":[{"value":"2079-9721","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,2]]}}}