Constipation with Sitz markers

Case contributed by Dr Matt A. Morgan

Presentation

History of chronic pain with chronic constipation.

Patient Data

Age: 39Y
Gender: Female
X-ray

Sitz Marker Study

On day 1, 23 out of the original 24 markers are within the field of view. Some in the ascending colon, but some are likely still in the small bowel.

The interpretation of this image depends on the colonic transit technique one is using, but one schedule expects ~16 rings at this time, so it would appear that in this case the colonic transit is too slow (as the copious stool in the colon suggests). The study should be extended to 5-6 days and most definitions of normal expect <20% of the original rings to remain.

On day 3, 18/24 markers are left in the colon, mostly in the transverse colon

On day 5, 17/24 markers are left in the colon, and they have only progressed forward a small amount. This is definitely too slow, and compatible with constipation.

There is an epidural catheter and multiple surgical clips overlie the left pelvis, likely from a piriformis muscle release.

Case Discussion

The Sitz marker study allows the gastroenterologist to grossly quantify the speed of colonic transit.

This can be useful if she or he wants to determine whether a patient's constipation is due to slow transit or due to a problem with defecation.

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Case information

rID: 37754
Case created: 21st Jun 2015
Last edited: 8th Sep 2015
Inclusion in quiz mode: Excluded

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