Ann Rehabil Med.  2013 Aug;37(4):547-555. 10.5535/arm.2013.37.4.547.

Plain Abdominal Radiograph as an Evaluation Method of Bowel Dysfunction in Patients With Spinal Cord Injury

• Park HJ
• Noh SE
• Kim GD
• Joo MC

• KMID: 2266611
• DOI: http://doi.org/10.5535/arm.2013.37.4.547

Abstract

OBJECTIVE
To evaluate the usefulness of plain abdominal radiography as an evaluation method for bowel dysfunction in patients with spinal cord injury (SCI).
METHODS
Forty-four patients with SCI were recruited. Patients were interviewed about their clinical symptoms, and the constipation score and Bristol stool form scale were assessed. The colon transit time (CTT) was measured by using radio-opaque markers (Kolomark). The degree of stool retention and the presence of megacolon or megarectum were evaluated using plain abdominal radiographs. We examined the relationship between clinical aspects and CTT and plain abdominal radiography.
RESULTS
The constipation scores ranged from 1 to 13, and the average was 4.19+/-3.11, and the Bristol stool form scale ranged from 1 to 6, with an average of 4.13+/-1.45. CTTs were 19.3+/-16.17, 19.3+/-13.45, 15.32+/-13.15, and 52.42+/-19.14 in the right, left, rectosigmoid, and total colon. Starreveld scores were 3.4+/-0.7, 1.8+/-0.86, 2.83+/-0.82, 2.14+/-1, and 10.19+/-2.45 in the ascending, transverse, descending, rectosigmoid, and total colon. Leech scores were 3.28+/-0.7, 2.8+/-0.8, 2.35+/-0.85, and 8.45+/-1.83 in the right, left, rectosigmoid, and total colon. The number of patients with megacolon and megarectum was 14 (31.8%) and 11 (25%). There were statistically significant correlations between the total CTT and constipation score (p<0.05), and Starreveld and Leech scores (p<0.05). Significant correlations were observed between each segmental CTT and the segmental stool retention score (p<0.05).
CONCLUSION
Plain abdominal radiography is useful as a convenient and simple method of evaluation of bowel dysfunction in patients with SCI.

Keyword

Neurogenic bowel; Spinal cord injuries; Abdominal radiography; Colon transit time

MeSH Terms

Colon
Constipation
Humans
Megacolon
Neurogenic Bowel
Radiography, Abdominal
Retention (Psychology)
Spinal Cord
Spinal Cord Injuries

Figure

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  Fig. 1 Starreveld score (A) and Leech score (B) for each segment were evaluated by plain abdominal radiographs.

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  Fig. 2 The inter-inspector reliability for the Starreveld score (A) and Leech score (B). There was a statistically significant correlation between the interpretations of the inspectors (r=0.913, r=0.922).

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  Fig. 3 The correlation of the total colon transit time (CTT) between Starreveld score (A) and Leech score (B). There was a statistically significant correlation between the methods (r=0.323, r=0.426).

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