skip to main content

Refractory faecal impaction — RACP Paediatrics MCQ

Instant feedback + full explanation. One question, done properly.

ModerateGIRefractory faecal impactionRACP Paediatrics

A 2-year-old with chronic constipation has been on macrogol for 3 months with good adherence but remains impacted despite adequate dosing. Parents are reluctant to use rectal interventions. Oral disimpaction regimens have been tried twice. What is the most appropriate next step?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: D — Rectal phosphate enema

When oral disimpaction with macrogol fails despite adequate dosing, a rectal phosphate enema may be required to achieve disimpaction. This should be performed by experienced staff in a clinical setting. Manual disimpaction under anaesthesia is reserved for severe refractory cases.

Reference: RCH Melbourne – 2023 – Constipation CPG; Australian Therapeutic Guidelines – 2024 – GI