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Slow-transit constipation — RACP Paediatrics MCQ

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HardGISlow-transit constipationRACP Paediatrics

A 6-year-old has had constipation since infancy despite long-term macrogol. Transit studies show significantly delayed colonic transit (markers scattered throughout the colon at 96 hours). Anorectal manometry shows normal recto-anal inhibitory reflex. What is the most likely diagnosis?

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Correct answer: D — Slow-transit constipation

Delayed colonic transit with markers scattered throughout the colon on transit study and normal RAIR (excluding Hirschsprung) suggests slow-transit constipation (colonic inertia). This is a motility disorder of the colon. Management includes optimised laxative therapy, and in severe refractory cases, surgical options (appendicostomy for antegrade continence enema/ACE) may be considered.

Reference: RCH Melbourne – 2023 – Constipation CPG; RACP Paediatric Curriculum – GI