Dolichocolon is common in pediatric gastroenterology patients with constipation and associated complaints

OBJECTIVES: Dolichocolon (DC), classified under International Classification of Diseases, Tenth Revision (ICD-10) code Q43.8 ("Other specified congenital malformations of intestine"), refers to an elongated or redundant large intestine. Recent studies in adults indicate a role for dolichocolon in constipation and disorders of gut-brain interaction. Contrast enema (CE) imaging is commonly used to identify DC, typically defined as a sigmoid colon extending above, or a transverse colon descending below, the iliac crest line. Despite its potential relevance, the prevalence and clinical significance of DC in pediatric gastroenterology remain poorly understood. METHODS: This retrospective study assessed the prevalence of DC in pediatric patients presenting with constipation and related gastrointestinal symptoms. A total of 155 contrast enemas from pediatric gastroenterology patients meeting predefined inclusion criteria were reviewed. Three blinded pediatric gastroenterologists independently evaluated each CE for features of colonic redundancy consistent with dolichocolon, based on a priori imaging criteria. RESULTS: Consensus-based identification (i.e., independent agreement among all three reviewers) of DC was observed in 74.1% of children under 2 years old and 88.6% of those aged 2-4 years presenting with constipation. The prevalence significantly decreased with age, with 68.8% in children aged 5-10 years and 47.6% in adolescents aged 11-17 years. CONCLUSIONS: These findings suggest that dolichocolon is common in pediatric patients with constipation and relatable symptoms, particularly in early childhood. Further research is warranted to clarify its clinical implications and potential role in pediatric gastrointestinal disorders.