Stool Retention Research Articles

Estudo de válvulas artificiais no cólon esquerdo após amputação abdominoperineal parcial do reto mais colostomia perineal, em cães

Throughout time, perineal colostomy in abdominoperineal resection, as a way to avoid abdominal colostomy, was studied. Perineal colostomy associated with a slowing down mechanism for stool transit has been studied for many years with satisfactory results. The investigation of a colic valvoplasty in dogs which have undergone an abdominoperineal resection plus perineal colostomy, and the discussion of the results achieved in clinic and histopathologic analysis are the objective of this study. The experimental model of this research studied the colon of dogs. Sixty five animals were operated and divided in five groups: 10 animals in the pilot group, 15 animals in control group and 40 animals in 3 other groups of observation with 10, 20 and 30 days of postoperative care. The dogs underwent a rectal partial abdominoperineal resection with perineal colostomy associated to a circumferential extramucosal seromiotomy of the left colon (except in the control group). Through postoperative and post-mortem observation it was possible to verify solid stool before the valves showing the efficiency of the mechanism in slowing it down. The histological analysis of the valves showed connective growth with fibrosis in the whole incised serous and muscular layers, separating them. A fibrous ring diminished the colon lumen in response to the artificial valve created by the scar that appeared in the inverted suture of the serous and muscular layers. The inflammatory fibrous repair process occurred in all valves, associated to foreign body type reactions and to partial stricture of the colon lumen. The circumferential seromiotomy produces a fibrous ring that provides stool retention on the descending colon.

Recurrent severe gastrointestinal bleeding and malabsorption due to extensive habitual megacolon

Dilatation of the colon and the rectum, which is not attributable to aganglionosis, is a rare finding and can be the result of intractable chronic constipation. We report a rare case of a 29-year-old male patient with impressive megacolon, in whom Hirschsprung's or Chagas disease was ruled out. In the present case, dilatation of the colon was most likely due to a behavioral disorder with habitual failure of defecation. Chronic stool retention led to a bizarre bulging of the large bowel with displacement of the other abdominal organs and severe occult blood loss. Because of two episodes of life-threatening gastrointestinal bleeding despite conventional treatment of constipation, a surgical approach for bowel restoration was necessary. Temporary loop ileostomy had to be performed for de-pressurization of the large bowel and the subsequent possibility for effective antegrade colonic lavage to remove impacted stools. Shortly after the operation, the patient was healthy and could easily manage the handling of the ileostomy. However, the course of the megacolon in this young adult cannot be predicted and the follow-up will have to reveal if regression of this extreme colonic distension with reestablishment of regular rectal perception will occur.

Saint Louis University School of Medicine

Saint Louis University School of Medicine

FUNCTIONAL CONSTIPATION IN CHILDREN

Constipation in children increases the likelihood of urinary incontinence, bladder overactivity, dyscoordinated voiding, a large capacity, poorly emptying bladder, recurrent urinary tract infection and deterioration of vesicoureteral reflux. We present a consensus related to the assessment, diagnosis and treatment of children with bowel dysfunction coexisting with a known disorder of urinary continence or voiding coordination. A panel of international multidisciplinary clinicians working on pediatric continence care was invited to participate in the First International Children's Continence Society Bowel Dysfunction Workshop. The seminar sought to address the interrelationship of bowel dysfunction with disorders of urinary continence or voiding mechanics. Constipation is an end point defined by a constellation of symptoms, including infrequent passage of stool, difficulty passing stool, feces that are either large and hard or in small pieces, abdominal pain, palpable stool in the abdomen, stool in the rectal vault, loading on x-ray or fecal soiling. Assessment was done to identify potential organic causes of constipation, clarify symptoms, and identify altered motor behavior and abdomino/pelvic floor muscle incoordination. Whether the underlying problem was one of stool consistency, poor cognition, motivation or fear on the part of the child, or whether it related to gut motility, rectal sensation, stool retention or disordered emptying mechanics, the definitive therapy begins with rectal emptying of impacted stool followed by maintenance of regular soft stools to eliminate fear of pain with defecation. Constipation is a challenge to the clinician but with comprehensive assessment and systematic intervention children can achieve independent bowel emptying, which positively impacts bladder function.

FAMILY HISTORY AND BEHAVIORAL ABNORMALITIES IN GIRLS WITH RECURRENT URINARY TRACT INFECTIONS: A CONTROLLED STUDY

We evaluated the role of family history, infrequent voiding, poor fluid intake, functional stool retention and inadequate anogenital hygiene or toilet habits in girls with recurrent urinary tract infections. The possible occurrence of these risk factors was assessed in 90 Swiss girls with recurrent urinary tract infections and in a control group of 45 girls. Family history was positive in 42% of patients and in 11% of controls (p <0.001). Behavioral abnormalities were also more frequently noted in girls with recurrent urinary tract infections than in the control group (81% vs 56%, p <0.01). There were 137 abnormalities in 73 girls with recurrent urinary tract infections and 30 abnormalities in 25 controls. Two or more abnormalities each, that is 2 in 32 girls and 3 in 16, were noted in 48 girls with recurrent urinary tract infections and in 5 control girls. No controls presented with more than 2 abnormalities. Infrequent voiding (54% vs 24%, p <0.001), poor fluid intake (53% vs 16%, p <0.001) and functional stool retention (30% vs 13%, p <0.05) were more frequently disclosed in girls with recurrent urinary tract infections than in control girls. In contrast, the frequency of inadequate stool hygiene or toilet habits was similar in patients and controls (14% and 13%, respectively). The evaluation of girls with recurrent urinary tract infections should focus on identifying behavioral aspects, including infrequent voiding, poor fluid intake and functional stool retention.

Digestive health in the elderly: faecal incontinence in adults.

Digestive health in the elderly: faecal incontinence in adults.

Long-Term Outcomes of the Ileal Pouch Anal Anastomosis: The Association of Bowel Function and Quality of Life 5 Years after Surgery

Introduction. Previous studies have reported that mean health related quality of life (HRQL) levels generally attain normalcy following construction of an ileal pouch anal anastomosis (IPAA). It appears inconsistent, however, that these normal HRQL levels are achieved while bowel function (BF) scores generally remain statistically worse than “normal” (e.g., 4–8 stools/day, possible anal leakage, diaper usage). To investigate this inconsistency, the current study attempts to determine if any statistical associations are present between HRQL and BF, specifically in the long term. Multivariate regression analyses are performed using each of 8 individual HRQL domains against the full model of BF characteristics.Methods. All patients more than 5 years status post an ileal pouch anal anastomosis (IPAA) procedure for familial adenomatous polyposis (FAP) at a single institution were studied. FAP was chosen because patients are routinely asymptomatic preoperatively. BF (e.g., stool frequency, anal leakage) and HRQL (using the 8 health domains of the SF-36) were assessed by patient interview. Student's t tests and full model multivariate regression analyses were used to analyze associations between BF and HRQL.Results. The sample included 25 patients (14 male). Mean age was 39 years, mean follow-up time was 11 years. Although mean scores for the 8 individual HRQL domains were not statistically different from the general United States population, regression analyses of the different domains did demonstrate significant associations with varying levels of BF. While controlling for age and gender, the analyses show that the physical function domain is improved with the ability to pass flatus independent of stool, and physical role and mental health domains are improved with decreased stool frequency. The social function domain is improved with increased stool retention time, while the perception of general health is improved with less diaper usage and less sexual dysfunction.Conclusions. This study shows that a statistically significant association between HRQL levels and BF is present. Of the numerous BF characteristics tested, five appear to be of greater importance with regard to certain HRQL domains. This finding may have clinical implications concerning pouch construction and surgical technique. Methodologically, this study demonstrates that merely using mean levels to describe HRQL may not elucidate meaningful relationships between important clinical outcomes, such as function and HRQL.

Frequency of digital rectal examination in children with chronic constipation.

To determine the frequency of performance of digital rectal examination by primary care practitioners on children with chronic constipation and to assess its effect on therapy. One hundred twenty-eight children referred for chronic constipation to the Division of Pediatric Gastroenterology at Schneider Children's Hospital, New Hyde Park, NY, as well as their parents were questioned as to whether a digital rectal examination was ever performed prior to referral. All children underwent subsequent digital rectal examination by a pediatric gastroenterologist and recommended treatment regimens were compared with pretreatment regimens. The patients evaluated were a mix of private-insurance and Medicaid patients referred by pediatricians in the general community. Ninety-eight (77%) of the children referred for chronic constipation were found to have never had a digital rectal examination performed prior to referral. Fifty-three (54%) of these children were found to have fecal impaction. Only 19 (21%) were found to have minimal to no stool retention on digital examination. Enema therapy had been infrequently used to "clean out" the colon in referred children. Seventy percent were treated with multiple enema therapy following digital rectal examination. Organic causes of constipation were identified in 3 patients. Digital rectal examination is often not performed in the examination of the child with chronic constipation. The digital examination can help differentiate functional constipation from an organic process and may alter the course of therapy.

How to resolve stool retention in a child

PREVIEWSoiled underwear is one of those problems that everyone wants fixed but no one wants to talk about. You, as the caregiver, may have to do a little detective work to uncover the problem and should do a lot of educating of the adults in charge. The reward may well be seeing a humiliated, shunned, scolded youngster transformed into a confident and happy one. The authors discuss how and why stool retention gets started, and they summarize the complaints parents often have when they bring in the child. A complete treatment regimen is described and compiled in a form that can be sent home with parents.

Hypoganglionosis

Only a few reports of intestinal hypoganglionosis (H) have been reported, mainly because of diagnostic difficulties. Persistent stool retention since birth and increasing distension of the colon are common to Hirschsprung's disease. It is extremely difficult to establish the diagnosis histochemically unless full-thickness biopsies are performed. Morphometric examination is essential for objective confirmation of the diagnosis. In H, the number of ganglion cells per longitudinal centimeter is decreased by a factor of 2, and the development of nerve fibers is scarce. Manometric findings are inconsistent, and barium studies of the colon and rectum may not provide answers regarding the underlying condition. Treatment of localized disease consists of resection followed by a Soave-type pull-through procedure. The etiology of H is still unknown, but an inborn hypoplasia of the parasympathetic myenteric plexus may be responsible. Among 353 rectal biopsies, 15 cases of H were detected. In seven children, it occurred as an isolated form, in four it was combined with distal aganglionosis, and in four it involved proximal intestinal neuronal dysplasia as well. After proper bowel preparation and resection of the hypoganglionic segment, the outcome was good for all patients. Secondary operations consisted of temporary colostomy in one patient due to anastomotic complications. One patient had an adhesive small bowel obstruction. In two patients with disseminated H of the small bowel and colon, resection was not indicated. Both are dependent on partial parenteral feeding since ages 9 and 3 years. It is expected that more cases of H will be diagnosed in the future, especially if diagnostic measures are improved. The diagnosis is likely in cases of persistent stool retention despite resection of an aganglionic segment.

Constipation and Encopresis in Childhood

Constipation and Encopresis in Childhood

Celiac Disease: An Uncommon Cause of Recurrent Intussusception

Celiac disease, one of the most common causes of intestinal malabsorption in childhood, is a mucosal reaction of the small intestine to gluten (1). The characteristic mucosal lesions, degeneration of epithelium and the cuticular layer, villous atrophy, and lymphoplasmocytic infiltration result in a diminished hydrolytic and resorbent function of the small intestine. Typical symptoms of general malabsorption are failure to thrive, large pungent stools, and a distended abdomen. The results of malnutrition are hypoproteinemia, iron deficiency, coagulopathy, and vitamin D deficiency. The symptoms differ in severity. Whereas constipation or intermittent ileus-like symptoms such as vomiting and stool retention with typical radiologic findings can occur in celiac disease, intussusception is rare (2,3). CASE REPORT A 3½-year-old girl with abdominal distension and diarrhea for 6 months had recurrent colicky abdominal pain for 2 weeks that always stopped spontaneously after several hours. On clinical examination during which the patient felt well, there was distended abdomen with increased intestinal peristalsis without other pathologic signs. Growth and weight were on the 10th percentile. Endomysium-immunoglobulin (Ig)A and IgG-antigliadin-antibodies were elevated (4-6). Other parameters were normal. During ultrasound performed while the patient was in abdominal pain, general thickening of the intestinal wall with high echogenicity (7) was seen as well as increased intestinal peristalsis and multiple presumably ileo-ileal intussusceptions (Figs. 1 and 2). These intussusceptions were seen for several days and reduced spontaneously. The mucosa of the small intestine showed villous atrophy and diminished disaccharidases and fructaldolases. Two weeks after being placed on a gliadin-free diet the girl was free of colicky complaints. Subsequently, on repeated ultrasound there was no sign of intussusception. DISCUSSION In childhood, intussusception usually occurs without obvious cause. Common triggers are: Meckel diverticulum, polyps, tumors, swelling of lymph nodes, cystic fibrosis, and Schoenlein-Henoch purpura. A correlation between intussusception and celiac disease is hardly mentioned in pediatric literature, whereas in adulthood, this combination is repeatedly described (3,8). Typical for intussusception of the small intestine seems to be a transient course with mild symptoms. One cause appears to be a disturbed peristalsis in the hypotonic intestinal loop (8). In this case, the correlation between celiac disease and repeated intussusception in different parts of the small intestine is obvious, especially because the recurrent intussusception stopped after starting the patient on a gliadin-free diet. Particularly in recurrent intussusception, celiac disease should be considered as a cause.FIG. 1.: Ultrasound showing thickening of the intestinal wall with high echogenicity and hyperperistalsis.FIG. 2.: Ultrasound showing three intussusceptions.

Defaecation disorders in children, colonic transit time versus the Barr-score.

It is still unclear how to evaluate the existence of faecal retention or impaction in children with defaecation disorders. To objectivate the presence and degree of constipation we measured segmental and total colonic transit times (CTT) using radio-opaque markers in 211 constipated children. On clinical grounds, patients (median age 8 years (5-14 years)) could be divided into three groups; constipation, isolated encopresis/soiling and recurrent abdominal pain. Barr-scores, a method for assessment of stool retention using plain abdominal radiographs, were obtained in the first 101 patients, for comparison with CTT measurements as to the clinical outcome. Of the children with constipation, 48% showed significantly prolonged total and segmental CTT. Surprisingly, 91% and 91%, respectively, of the encopresis/soiling and recurrent abdominal pain children had a total CTT within normal limits, suggesting that no motility disorder was present. Prolonged CTT through all segments, known as colonic inertia, was found in the constipation group only. Based on significant differences in clinical presentation, CTT and colonic transit patterns, encopresis/soiling children formed a separate entity among children with defaecation disorders, compared to children with constipation. Recurrent abdominal pain in children was in the great majority, not related to constipation. Barr-scores were poorly reproducible, with low inter- and intra-observer reliability. This is the first study which shows that clinical differences in constipated children are associated with different colonic transit patterns. The usefulness of CTT measurements lies in the objectivation of complaints and the discrimination of certain transit patterns. Conclusion. Abdominal radiographs, even when assessed with the Barr-score proved unreliable in diagnosing constipation.(ABSTRACT TRUNCATED AT 250 WORDS)

Comparative studies on the usefulness of phosphate versus glycerin enema in preparation for colon examinations

Fifty of 100 persons who had undergone health screening received phosphate enema while the other 50 received glycerin enema prior to proctoscopy and barium enema, and their usefulness for preparation for colon examination was compared by a double-blind test. There was no significant difference in the degree of colonic cleansing achieved by proctoscopy and barium enema. In the subjects who received phosphate enema, the incidence of abdominal pain was less than that in those who received glycerin enema, while the effect of phosphate enema on defecation appeared later than that of glycerin enema, indicating prolonged stool retention in the subjects given phosphate enema. To study the safety of the two enemas, either phosphate enema, glycerin enema or physiological saline solution as a control was administered at 0.35 ml/animal in the rectum by 4-h closure of the anus in 10 male 7-week-old Wistar rats, and the rectal mucosa was observed for irritation macroscopically and histopathologically. Glycerin enema produced less irritation than phosphate enema diffusely in the entire area of the rectum, while phosphate enema produced more local irritation at the end of the rectum than glycerin enema. The differences in the extent of irritation and injury between phosphate and glycerin enemas were considered to be derived from differences in the pharmacologic actions of these drugs. If the extent of injury were included in the extent of irritation, the difference in irritation between phosphate and glycerin enemas would not be significant. As described above, no specific difference seem to exist in the usefulness of phosphate and glycerin enemas as preparation for colon examination.

Clinical and radiological diagnosis of obstruction of the digestive tract in newborns and infants

Obstruction of the digestive tract in newborns and infants is often characterized by vomiting, stool retention (meconium), abdominal bloating, visible increased peristalsis in the first hours of the disease. However, these symptoms are nonspecific and may be observed not only in surgical but also in somatic, therapeutic diseases: sepsis, otitis media, pneumonia, intestinal infections. Associated complications, often a combination of several malformations of the digestive tract, heart and, finally, late admission of the child to the surgical hospital significantly complicate the clinical diagnosis of congenital, acquired, functional and organic disorders of gastrointestinal tract patency.

A study of treatment resistance among children referred for encopresis.

This study reports on some of the distinguishing characteristics of children with persistent encopresis who have proven, at long-term follow-up, to be resistant to intensive pediatric-based treatment at a referral outpatient clinic. Resistant children differed from responsive children primarily in two respects: they tended to have less stool retention at initial presentation, and their accidents occurred at all hours of the day. Additional information suggested that early success or failure did not presage long-term resistance and that parents' attributions of the cause of their child's soiling were related to outcome. Discussion centered on enumerating important high-risk factors that signal the need for more intensive intervention and follow-up.

Abdominal Pain in the Female Adolescent

The diagnosis of abdominal pain is difficult. It requires additional skills and care when the patient is an adolescent. Although the approach required to diagnose a specific disease entity known to be causing the pain symptom is easy, the decisions to take when the patient has the complaint without specific signposts pointing to one entity or another is difficult. In the acute presentation, the decision as to which tests to order or which therapies to initiate must be made almost totally on presenting symptoms and signs. Often the definitive test necessary for the differential (eg, urine culture, cervical culture for gonococcus) will not be reported by the time a clinical decision must be made. In the recurrent presentation, more time is available, but the yield from invasive and expensive tests is lower and more difficult to justify. There are no data prospectively collected in a representative sample of adolescents presenting with abdominal pain in whom a systematic approach to diagnosis was utilized. Thus the relative likelihood of finding urinary tract infection or pelvic inflammatory disease accounting for the symptom, or the relative usefulness of a barium enema examination vs laparoscopy for evaluation of right lower quadrant pain is unknown. As a result, emphasis in this description has been placed on presenting symptoms and signs. Recognizing that diagnostic clinical judgment often involves pattern recognition, typical presentations have been stressed. However, it should be apparent that this will be insufficient to guarantee diagnostic accuracy. Two of the main reasons for this are the similarity of presentation of so many entities, and the prevalence of atypical presentations. However, a number of principles can be recommended (Table 2): (1) adolescents have different presentations than do younger children; (2) contrary to common belief, adolescents have different presentations than do adults; (3) be aware of increasing prevalence in adolescents of entities that cause abdominal pain at all ages; (4) be aware of entities relating to the genitourinary tract entering into the differential diagnosis; (5) be aware of entities related to life-style changes and exposure to environmental precipitants; (6) appropriate evaluation of the problem of abdominal pain includes assessment of the symptom, the anxiety secondary to the symptorm, and the dysfunction secondary to the symptom; (7) history taking requires excellent communication to overcome shyness relating to patient9s self-awareness of sexuality or outright denial of the symptom9s significance; (8) appropriate evaluation most often includes a sensitive, expertly performed pelvic examination by an experienced examiner (Cowell) (9) in acute pain presentations, clinical judgment requires consideration of the potential negative consequences of missed surgical abdomen, and surgical/gynecologic consultation is often indicated; (10) in recurrent pain presentations, evaluations other than base line tests (history, physical, and pelvic examinations, blood count, ESR, urinalysis, and culture) should not be shotgun but used selectively and staged according to relative likelihood of the entity being sought, and usefulness of the procedure in detecting it. Enrollment of the patient as a coinvestigator and use of a diary has been found to be helpful in detecting patterns and focusing secondary anxiety about the symptom. It has been estimated that well over 100 entities may present as abdominal pain. Many common (eg, stool retention, gastroenteritis, Mittelschmerz) and less common (eg, abdominal tumors, endometriosis) entities that enter the differential diagnosis agnosis have not been discussed. In the face of these possibilities, I usually adopt the following strategy: (1) with acute pain presentations, to consider first entities with potentically severe consequences requiring early definitive treatment (eg, appendicitis, ectopic pregnancy, ovarian torsion, pelvic inflammatory disease) and to move down the differential only when there is good evidence that these first entities are not implicated; and (2) with recurrent presentations, to consider first entities that are most common (eg, nonspecific recurrent abdominal pain, irritable bowel syndrome) and to move up the differential to further investigation only when there is good evidence implicating other specific entities. However, no strategy will be appropriate for all situations, and we are far from having a successful recipe for diagnostic success with abdominal pain in adolescents.

Abdominal Pain in the Female Adolescent

The diagnosis of abdominal pain is difficult. It requires additional skills and care when the patient is an adolescent. Although the approach required to diagnose a specific disease entity known to be causing the pain symptom is easy, the decisions to take when the patient has the complaint without specific signposts pointing to one entity or another is difficult. In the acute presentation, the decision as to which tests to order or which therapies to initiate must be made almost totally on presenting symptoms and signs. Often the definitive test necessary for the differential (eg, urine culture, cervical culture for gonococcus) will not be reported by the time a clinical decision must be made. In the recurrent presentation, more time is available, but the yield from invasive and expensive tests is lower and more difficult to justify. There are no data prospectively collected in a representative sample of adolescents presenting with abdominal pain in whom a systematic approach to diagnosis was utilized. Thus the relative likelihood of finding urinary tract infection or pelvic inflammatory disease accounting for the symptom, or the relative usefulness of a barium enema examination vs laparoscopy for evaluation of right lower quadrant pain is unknown. As a result, emphasis in this description has been placed on presenting symptoms and signs. Recognizing that diagnostic clinical judgment often involves "pattern recognition," typical presentations have been stressed. However, it should be apparent that this will be insufficient to guarantee diagnostic accuracy. Two of the main reasons for this are the similarity of presentation of so many entities, and the prevalence of atypical presentations. However, a number of principles can be recommended (Table 2): (1) adolescents have different presentations than do younger children; (2) contrary to common belief, adolescents have different presentations than do adults; (3) be aware of increasing prevalence in adolescents of entities that cause abdominal pain at all ages; (4) be aware of entities relating to the genitourinary tract entering into the differential diagnosis; (5) be aware of entities related to life-style changes and exposure to environmental precipitants; (6) appropriate evaluation of the problem of abdominal pain includes assessment of the symptom, the anxiety secondary to the symptorm, and the dysfunction secondary to the symptom; (7) history taking requires excellent communication to overcome shyness relating to patient's self-awareness of sexuality or outright denial of the symptom's significance; (8) appropriate evaluation most often includes a sensitive, expertly performed pelvic examination by an experienced examiner (Cowell) (9) in acute pain presentations, clinical judgment requires consideration of the potential negative consequences of missed "surgical" abdomen, and surgical/gynecologic consultation is often indicated; (10) in recurrent pain presentations, evaluations other than base line tests (history, physical, and pelvic examinations, blood count, ESR, urinalysis, and culture) should not be "shotgun" but used selectively and staged according to relative likelihood of the entity being sought, and usefulness of the procedure in detecting it. Enrollment of the patient as a "coinvestigator" and use of a diary has been found to be helpful in detecting patterns and focusing secondary anxiety about the symptom. It has been estimated that well over 100 entities may present as abdominal pain. Many common (eg, stool retention, gastroenteritis, Mittelschmerz) and less common (eg, abdominal tumors, endometriosis) entities that enter the differential diagnosis agnosis have not been discussed. In the face of these possibilities, I usually adopt the following strategy: (1) with acute pain presentations, to consider first entities with potentically severe consequences requiring early definitive treatment (eg, appendicitis, ectopic pregnancy, ovarian torsion, pelvic inflammatory disease) and to move "down" the differential only when there is good evidence that these first entities are not implicated; and (2) with recurrent presentations, to consider first entities that are most common (eg, nonspecific recurrent abdominal pain, irritable bowel syndrome) and to move "up" the differential to further investigation only when there is good evidence implicating other specific entities. However, no strategy will be appropriate for all situations, and we are far from having a successful recipe for diagnostic success with abdominal pain in adolescents.

Strangulated intestinal obstruction with extensive necrosis of the small intestine in an elderly patient

Diagnosis and treatment of acute intestinal obstruction is extremely difficult, especially in elderly and senile people. I., 90 years old, was admitted to the surgical department on 14 / ІХ 1980 at 21 hours with complaints of severe abdominal pain of a constant nature, vomiting of bile, stool retention, severe weakness. Suddenly fell ill on 13 / IX: at 9 o'clock there were severe cramping pains in the abdomen, vomiting, severe weakness. Over time, the pain became constant, vomiting did not stop. Within 36 hours before admission to the surgical department, the patient was repeatedly examined by emergency doctors. In 1970, the patient underwent surgery for gangrenous appendicitis. Such an attack marks the first time.

Chronic and occult stool retention: a clinical tool for its evaluation in school-aged children.

A scoring method was developed to assess severity of stool retention using plain abdominal radiographs. To determine whether the technique was clinically valid in identifying chronic stool retention, the method was used to evaluate films taken of children with known stool retention before and after therapy. The method showed significant statistical differences between symptomatic pre-therapy films and controls and between pre- and post-therapy films of treatment "successes." No significant differences were found between pre- and post-therapy "failures." Use of radiographs is not a substitute for careful history taking and examination, but this scoring method for evaluating stool retention can be recommended prior to more extensive, invasive investigations in children presenting with functional abdominal complaints.