E5338. A Tailored Imaging Approach for Constipation in Adults
  1. Sriram Jaganathan; University of Texas Health Science center
  2. Bryan Foster; Oregon Health and Science University
  3. Priya Bhosale; MD Anderson cancer center
  4. Mayur Virarkar; University of Florida
  5. Hagar Samir Mahmoud; University of Connecticut
  6. Mohd Zahid; University of Alabama
  7. Apurva Bonde; University of Texas Health Science center
Constipation is a common complaint that has multifactorial pathogenesis and may be due to a variety of causes. Appropriate management requires an evaluation of secondary etiologies where imaging plays a crucial role. Imaging also helps in eliminating the secondary causes and making a diagnosis of idiopathic constipation that is associated with normal or slow colonic transit, defecatory dysfunction (pelvic floor dysfunction), or both.

Educational Goals / Teaching Points
Discuss the etiology of constipation, indications on when to image, and a tailored imaging strategy for further evaluation. Present the spectrum of imaging findings of secondary constipation on various imaging modalities. Imaging spectrum of the complications including stercoral colitis, diverticulitis, and perianal abscess.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Our exhibit includes the criteria for diagnosis (ROME IV criteria) of constipation, and the role of imaging in the identification of structural causes such as intrinsic obstruction that includes colon cancer (annular), colonic stricture, volvulus, intussusception, or external compression from other masses. We also include various benign conditions including inflammatory bowel disease (ulcerative colitis) and constipation secondary to local or systemic diseases. Local pathologies leading to constipation would include pelvic abscesses and the list of systemic secondary causes includes endocrine, cystic fibrosis, neurological disorders, and adult Hirschsprung’s disease. Additionally, the complications of constipation such as stercoral colitis, ischemia, perforation, fecal impaction, anal fissure, fistula, diverticulitis, and abscesses are included with illustrations.

Though the primary diagnosis of constipation is based on clinical criteria, imaging plays a crucial role in the diagnosis of secondary causes and in identifying the complications that help in improving the quality of life in these patients.