Colonic transit studies: normal values for adults and children with comparison of radiological and scintigraphic methods

The sitz or plastic marker study for colonic transit has been around for many years. It is applicable where an X-ray machine exists, is widely used and is accepted as the gold standard for diagnosing constipation. Recently, radiopharmaceutical methods have been developed. The theme of this review is their possible roles in the assessment of paediatric bowel motility disorders in patients presenting to paediatric surgeons. This review presents data on total and segmental transit in normal adults and children and comparing the two techniques in adults. Reliability and reproducibility are presented. Normative data for colonic transit in adults and children are discussed and parameters for assessing abnormal transit are reviewed. Normal colonic transit takes 20–56 h. Plastic marker studies are more readily accessible, but the assessment may be misleading with current methods. Plastic markers show faster transit than scintigraphy. It is difficult to compare the two techniques because methods of reporting are different. Using scintigraphy, repeatability is good. Separation of normal from slow transit in the ascending colon is apparent at 24 and 48 h, but the determination of transit through the distal colon/rectum in adults may require studies of more than 7 days. In conclusion, plastic marker studies and scintigraphy show similar transit rates in young adults and children. However, scintigraphy has advantages of allowing transit through the stomach and small intestine to be measured and has proved useful in the diagnostic workup of children with intractable constipation.     

Slow-transit constipation with concurrent upper gastrointestinal dysmotility and its response to transcutaneous electrical stimulation

Purpose

Transcutaneous electrical stimulation (TES) speeds up colonic transit in children with slow-transit constipation (STC). This study examined if concurrent upper gastrointestinal dysmotility (UGD) affected response to TES.

Methods

Radio-nuclear transit studies (NTS) were performed before and after TES treatment of STC as part of a larger randomised controlled trial. UGD was defined as delayed gastric emptying and/or slow small bowel transit. Improvement was defined as increase of ??1 Geometric Centre (median radiotracer position at each time [small bowel?=?1, toilet?=?6]).

Results

Forty-six subjects completed the trial, 34 had NTS after stimulation (21?M, 8?C17?years, mean 11.3?years; symptoms >9?years). Active stimulation increased transit in >50% versus only 25% with sham (p?=?0.04). Seventeen children also had UGD. In children with STC and either normal upper GI motility (NUGM) and UGD, NTS improved slightly after 1?month (57 vs. 60%; p?=?0.9) and more after 2?months (88 vs. 40%; p?=?0.07). However, mean transit rate significantly increased with NUGM, but not UGD (5.0?±?0.2: 3.6?±?0.6, p?<?0.01).

Conclusion

Transcutaneous electrical stimulation was beneficial for STC, with response weakly associated with UGD. As measured by NTS, STC children with NUGM responded slightly more, but with significantly greater increased transit compared to those with UGD. Higher numbers are needed to determine if the difference is important.     

Gastrointestinal transit in children with chronic idiopathic constipation

Abstract  Chronic constipation in children is common and produces significant morbidity. Identification of the site of dysmotility in constipation may determine the cause and permit directed management. Scintigraphy differentiates constipated patients with anorectal hold-up from those with colonic slowing. Adults with colonic slowing demonstrate variation in the site of hold-up. However, in children with colonic slowing, variability in the site of hold-up has not been investigated. Purpose  The current study aimed to characterise colonic transit patterns in 64 children with chronic idiopathic constipation. Methods  Scintigraphic images were grouped visually by their transit patterns. Intra-observer variation was assessed. Scintigraphic data were analysed quantitatively. Results  Visual analysis of scintigraphy studies demonstrated normal transit (11/64), anorectal hold-up (7/64) and slow colonic transit (46/64). Transit characteristics in the slow transit group demonstrated three possible subgroups: pancolonic slowing (28/46), discrete hold-up in the transverse colon (10/46) and abnormal small and large bowel transit (8/46). Kappa testing demonstrated consistent characterisation (k = 0.79). Statistical analysis of scintigraphic data demonstrated highly significant differences from normal (P < 0.001) in the subgroups. Conclusion  Scintigraphy demonstrates three possible transit patterns in children with chronic constipation secondary to slow colonic transit.     

便秘患儿的胃肠传输时间测定及其意义

目的　初步测定正常中国儿童的胃肠传输时间并探讨胃肠传输时间对小儿便秘的病因、诊断和分型的意义。方法　研究对象分为对照组和便秘组。对照组 3 3例 ,男 2 1例 ,女 12例 ,平均年龄 5岁。便秘组 2 5例 ,男 15例 ,女 10例 ,平均年龄 7岁 ,均符合Benninga的便秘诊断标准。应用简化的不透X线标记物追踪法 ,即多次口服标记物一次摄片法测定正常和便秘儿童的全胃肠传输时间 (Totalgastrointestinaltransittime,TGITT)和节段性结肠传输时间 ,包括 :右半结肠传输时间 (Rightcolonictransittime ,RCTT) ;左半结肠传输时间 (Leftcolonictransittime ,LCTT)和直肠乙状结肠传输时间(Rectosigmoidcolonictransittime ,RSTT) ;部分患儿联合应用X线排便造影 ,探讨便秘的诊断和分型 ;结果　正常儿童的TGITT ,RCTT ,LCTT和RSTT分别为 2 8 7± 7 7小时、7 5± 3 2小时、6 5± 3 8小时和 13 4± 5 6小时 ;便秘组的TGITT ,LCTT和RSTT较对照组明显延长 (92 2± 5 5 5小时vs 2 8 7± 7 7小时 ,P <0 0 0 1;16 9± 12 6小时vs 6 5± 3 8小时 ,P <0 0 1;和 61 5± 2 9 0小时vs 13 4± 5 6小时 ,P <0 0 0 1)。RCTT无显著变化。X线排便造影显示直肠前突、会阴下降综合征和耻骨直肠肌痉挛综合征各 1例。结论　首次     

不同型别的功能性便秘患儿肛门直肠测压对照研究

目的探讨功能性便秘（FC）患儿与健康儿童肛门直肠动力学差异,为其临床分型诊断及治疗提供依据。方法采用功能性胃肠病罗马Ⅲ诊断标准,收集2008年1月至2009年1月在第四军医大学唐都医院儿科门诊及住院的FC患儿为FC组。选取同期无消化系统症状,平日排便正常的健康儿童为正常对照组。采用不透光X线硫酸钡条测定结肠传输指数（TI）,依据TI将FC组分为出口梗阻型（OOC）亚组、慢传输型（STC）亚组和混合型（MIX）亚组。通过肛门直肠测压法分析FC各亚组与正常对照组肛门直肠动力学差异。结果研究期间FC组纳入25例,其中STC亚组10例,OOC亚组15例,未发现MIX患儿;正常对照组纳入10名。FC组与正常对照组肛门括约肌静息压差异无统计学意义（P＞0.05）。STC亚组肛门括约肌最大收缩压与正常对照组差异无统计学意义（P＞0.05）,OOC亚组肛门括约肌最大收缩压显著高于正常对照组及STC亚组（P＜0.05）。FC组直肠最低敏感量及最大耐受量均显著高于正常对照组（P均＜0.05）。STC亚组与OOC亚组直肠最低敏感量及最大耐受量差异均无统计学意义（P均＞0.05）。结论FC患儿存在明显的肛门直肠动力和感觉异常;OOC和STC患儿的肛门直肠动力学存在差异。肛门直肠测压检查对协助诊断FC有一定价值。     

Defaecation disorders in children,colonic transit time versus the Barr-score

It is still unclear how to evaluate the existence of faecal retention or impaction in children with defaecation disorders. To objectivate the presence and degree of constipation we measured segmental and total colonic transit times (CTT) using radio-opaque markers in 211 constipated children. On clinical grounds, patients (median age 8 years (5–14 years)) could be divided into three groups; constipation, isolated encopresis/soiling and recurrent abdominal pain. Barr-scores, a method for assessment of stool retention using plain abdominal radiographs, were obtained in the first 101 patients, for comparison with CTT measurements as to the clinical outcome. Of the children with constipation, 48% showed significantly prolonged total and segmental CTT. Surprisingly, 91% and 91%, respectively, of the encopresis/soiling and recurrent abdominal pain children had a total CTT within normal limits, suggesting that no motility disorder was present. Prolonged CTT through all segments, known as colonic inertia, was found in the constipation group only. Based on significant differences in clinical presentation, CTT and colonic transit patterns, encopresis/soiling children formed a separate entity among children with defaecation disorders, compared to children with constipation. Recurrent abdominal pain in children was in the great majority, not related to constipation. Barr-scores were poorly reproducible, with low inter-and intra-observer reliability. This is the first study which shows that clinical differences in constipated children are associated with different colonic transit patterns. The usefulness of CTT measurements lies in the objectivation of complaints and the discrimination of certain transit patterns.Conclusion Abdominal radiographs, even when assessed with the Barr-score proved unreliable in diagnosing constipation. Marker studies should be performed in the second stage of evaluation after failure of initial therapy.     

结肠传输时间测定和直肠肛管测压在儿童便秘中的意义

目的　小儿便秘的病理生理基础目前尚不清楚,该文对结肠传输时间和直肠肛管测压在儿童便秘 中应用的意义进行初步探讨。方法　对28例便秘儿童(便秘组)和43例正常儿童(对照组)进行全胃肠传输时间 (TGITT)、左半结肠传输时间(LCTT)、右半结肠传输时间(RCTT)和直肠乙状结肠传输时间(RSTT)测定和直肠肛 管向量测压(包括肛管压力、向量容积和对称指数)。根据结肠传输时间是否超过对照组均值加两个标准差将28 例便秘儿童分为传输时间正常型便秘组和传输时间延长型便秘组。结果　便秘组儿童TGITT、LCTT和RSTT较对 照组均显著延长(92±56hvs29±8h,17±13hvs7±4h,62±29hvs13±6h)(P均<0.01),肛管最大收缩压显 著升高(216±44mmHgvs190±38mmHg)(P<0.05),对称指数显著降低(0.71±0.06vs0.84±0.08)(P< 0.05),两组RCTT正常。传输时间正常型便秘组和传输时间延长型便秘组儿童肛管最大压力、向量容积和对称指 数差异无显著意义。结论　便秘儿童的结肠传输功能和/或直肠肛管动力存在不同程度异常;无论结肠传输时间 正常与否,所有便秘患儿均应进行直肠肛管测压检查。     

‘Rapid transit’ constipation in children: a possible genesis for irritable bowel syndrome

Children with chronic idiopathic constipation (CIC) often end up at the surgeon when medical treatments have failed. This opinion piece discusses a recently described pattern of CIC called ‘Rapid transit constipation (RTC)’ first identified in 2011 as part of surgical workup. RTC was identified using a nuclear medicine gastrointestinal transit study (NMGIT or nuclear transit study) to determine the site of slowing within the bowel and to inform surgical treatment. Unexpectedly, we found that RTC occured in 29% of 1000 transit studies in a retrospective audit. Irritable bowel syndrome (IBS) occurs in 7–21% of the population, with a higher prevalence in young children and with constipation type dominating in the young. While 60% improve with time, 40% continue with symptoms. First-line therapy for IBS in adults is a diet low in fermentable oligosaccharides, disaccharides, monosaccharides and polyols which reduces symptoms in > 70% of patients. In children with functional gastrointestinal disorders, fructose intolerance occurs in 35–55%. Reducing fructose produced significant improvement in 77–82% of intolerant patients. In children with RTC and a positive breath test upon fructose challenge, we found that exclusion of fructose significantly improved constipation, abdominal pain, stool consistency and decreased laxative use. We hypothesise that positive breath tests and improvement of pain and bowel frequency with sugar exclusion diets in RTC suggest these children have IBS-C. These observations raise the possibility that many children with CIC could be treated by reducing fructose early in their diet and this might prevent the development of IBS in later life.     

Chronic constipation in children: organic disorders are a major cause

Diagnostic tools for paediatric chronic constipation have been limited, leading to over 90% of patients with treatment-resistant constipation being diagnosed with chronic idiopathic constipation, with no discernible organic cause. Work in our institution suggests that a number of children with intractable symptoms actually have slow colonic transit leading to slow transit constipation. This paper reviews recent data suggesting that a significant number of the children with chronic treatment-resistant constipation may have organic causes (slow colonic transit and outlet obstruction) and suggests new approaches to the management of children with chronic treatment-resistant constipation.     

Scintigraphy evaluation of the types of functional constipation in children with bowel bladder dysfunction

PurposeTo evaluate the types of constipation according to colonic transit time in chronically constipated children with dysfunctional voiding (bowel bladder dysfunction, BBD group) and to compare the results with transit type in children with chronic functional constipation without urinary symptoms (constipation group) and children with normal bowel habits, but with lower urinary tract symptoms (control group).Patients and methodsOne-hundred and one children were included and their medical histories were obtained. The BBD group kept a voiding diary, and underwent urinalyses and urine culture, ultrasound examination of bladder and kidneys and uroflowmetry with pelvic floor electromyography. Radionuclear transit scintigraphy was performed in all children according to a standardized protocol. Patients were categorized as having either slow-transit (ST), functional fecal retention (FFR) or normal transit.ResultsFFR was diagnosed in 31 out of 38 children with BBD, and 34 out of 43 children in the constipation group. ST was found in seven children with BBD, compared with nine children in the constipation group. The control group children demonstrated normal colonic transit. Urgency, daily urinary incontinence and nocturnal enuresis were noted only in children with FFR. Both children with ST constipation and FFR complained of difficulties during voiding, voiding postponement and urinary tract infections.ConclusionsFFR is the most common form of constipation in children with dysfunctional voiding. However, some children might suffer from ST constipation. Differentiation between these two types of constipation is clinically significant because they require different treatment. Future studies with larger numbers of patients are needed to confirm the noted differences in urological symptoms in these two groups of constipated children..     

Biopsychosocial treatment of defecation problems in children with anal atresia: a retrospective study

 In a retrospective study, we examined whether multidisciplinary treatment based on a biopsychosocial approach and carried out by a pediatric surgeon, a child psychologist, and a pediatric physiotherapist is successful in reducing defecation problems (incontinence and/or constipation) in children with operated anal atresia (AA) (mean age 6.9 ± 4.01 years). A second question was whether this treatment is successful in young children aged 2–5 years. The multidisciplinary approach consisted of standard medical treatment and a behavioral program to teach children and their parents adequate defecation behavior including an adequate straining technique. Forty-three children aged 2–16 years were included: 27 boys and 16 girls with AA, of whom 26 had high or intermediate and 17 low AA. Besides continence and constipation, defecation behavior and straining technique were evaluated. The children improved significantly during treatment in all aspects of defecation. No differences in effect of treatment were found between young children (2–5 years) and older ones, so this treatment seems to be equally effective in both age groups. This study demonstrates that both somatic and behavioral factors contribute to the persistence of chronic defecation problems. It is concluded that treatment of these problems in patients with operated AA should include behavioral modification techniques. Accepted: 1 February 2000     

The clinical value of solid marker transit studies in childhood constipation and soiling

Assessment of constipation in childhood is difficult, particularly when the presenting symptom is spurious diarrhoea or faecal incontinence. We have therefore assessed the clinical usefulness, reliability and acceptibility of a solid marker transit technique in 52 patients with constipation (median age 8.0 years; range 2–13.5 years) at two referral centres. Median duration of symptoms was 60 months. Soiling was a prominent feature in 43 children (83%). Ten, 3 mm pieces of 6FG radio-opaque Silastic tubing were given orally at 9am on days 1, 2 and 3 and a plain abdominal film taken on day 5. Laxative treatment was not interrupted. Each film was divided into right colon, left colon and rectosigmoid areas, using bony landmarks, and the marker content of each area counted. The coefficient of variation of intra and inter-observer errors was 3.1% and 2.1% respectively. By day 5, 7% (group median) of markers were still in the right colon, 17% in the left colon and 42% in the rectosigmoid. Twenty-one patients(40%) had normal transit, 4 (8%) mild delay, 9 (17%) moderate and 18 (35%) severe transit delay. Marker distribution indicated slow pancolonic transit in 29% and slow segmental transit in 10%. In 21%, clustering of markers in the rectosigmoid suggested outlet obstruction. A significant correlation was found between both transit delay and marker distribution and the severity of clinical symptoms of constipation and soiling. Repeat studies in six children following colonic evacuation revealed significant improvement (P< 0.05) in marker transit. The test was well tolerated and was useful in establishing the diagnosis of constipation in children with soiling or spurious diarrhoea and in assessment of its severity and its response to treatment.     

Clinical application of wireless capsule endoscopy in pediatric patients for suspected small bowel diseases

Capsule endoscopy (CE) has been demonstrated to be safe and well tolerated in adults with suspicion of small intestinal diseases with negative results of gastroscopy and colonoscopy. However, its value in pediatric patients has not yet been well studied. This study aimed to evaluate the results and safety of CE in pediatric patients with suspicion of small bowel disorders. There were 16 consecutive children and adolescents (12 boys, 4 girls) and 15 adults (9 men, 6 women) referred to us for suspected small bowel diseases from August 2002 to September 2005. Among the pediatrics, six patients were less than 10 years old. Technique for capsule placement, gastric transit time, small bowel transit time, excretion time of capsule endoscopy, capsule findings, and complications were recorded. All 16 pediatric patients described that the capsule was easy to swallow except for three children. Finally we delivered the capsule under gastroscopy with overtube for these three children. No capsule retention occurred during our study. Median recording time was 7 h 44 min (range 6 h 51 min–9 h 11 min). Median gastric transit time was 83.5 min (range 4–296 min). Median small bowel transit time was 270 min (range 142–484 min).Median excretion time of capsule was 33.9 h (range 12–96 h). There was no significant difference in excretion time of capsule, gastric transit time and small bowel transit time between pediatric patients and adult patients (P > 0.05). CE was positive in 12 patients, including Crohn’s disease (4), hemangioma (2), angiodysplasia (2), Meckel diverticulum (1), polyp (1), aphthous ulcer in ascending colon (1), and cobblestone appearance of ileal mucosa. CE has been performed safely in a small series of pediatric patients after ingestion or endoscopic placement of the capsule. The high yield of abnormal findings was comparable to those of adult patients. Supported by Shanghai Leading Academic Discipline Project (Project number: Y0205).     

Gender differences in reduced substance P (SP) in children with slow-transit constipation

Purpose  

Adult slow-transit constipation (STC) occurs predominantly in females and is associated with low numbers of substance P (SP)-containing nerves in colonic circular muscle.     

Orocoecal Transit Time in Healthy and Constipated Children

ABSTRACT. Orocoecal transit time (OCTT), assessed by means of H₂ breath test after lactulose and/or after a semisolid standard meal, was studied in normal and constipated children. Both control subjects and patients with constipation showed a significantly longer OCTT after a standard meal than after lactulose ingestion ( p <0.01). Whereas the OCTT after lactulose did not differ in the two groups, the constipated patients had a significantly longer transit time after a standard meal when compared to controls ( p <0.05). No correlation was observed within each group between the OCTT after a standard meal or after lactulose ingestion ( r =-0.077; p >0.1). These findings suggest that 1) measurement of the transit of a standard meal instead of a lactulose solution may offer more direct insight into the role of small intestinal transit of food, both in physiological and pathological conditions, 2) gastrointestinal segments other than colon may play a role in chronic non organic constipation of childhood.     

Thromboelastography of Patients After Fontan Compared with Healthy Children

Patients who have undergone a Fontan procedure face an increased risk for thromboembolic complications. This study aimed to evaluate whether thromboelastography, a global whole-blood assay of coagulation, can be used to detect hypercoagulability in pediatric Fontan patients compared with healthy children. This prospective, cross-sectional study investigated 25 Fontan patients and 51 healthy children in three age groups: 1–5 years, 6–10 years, and 11–16 years. Kaolin-activated thromboelastography was performed on citrated samples. No statistically significant differences in thromboelastography parameters were found among the different age groups of the 51 healthy children. None of the 25 Fontan patients demonstrated evidence of hypercoagulability on thromboelastography (95% confidence interval, 0–7%), as defined by two standard deviations above or below the normal mean. The findings suggest that the percentage of Fontan patients demonstrating hypercoagulability on thromboelastography is substantially lower than the reported incidence of thromboembolic complications. Whether thromboelastography could be helpful in predicting patients at increased risk for thromboembolic complications or not still is not known. Further studies comparing the thromboelastography of Fontan patients with the thromboembolic complications of those without Fontan are needed to delineate these issues.     

Diagnostic accuracy of the Barr and Blethyn radiological scoring systems for childhood constipation assessed using colonic transit time as the gold standard

Background  Constipation is a common childhood symptom and abdominal radiography is advocated in diagnosis and management. Objective  To assess the reproducibility and diagnostic accuracy of the Barr and Blethyn systems for quantifying constipation on abdominal radiographs in children. Materials and methods  Radiographs were scored by three observers of increasing radiological experience (student, junior doctor, consultant). Abdominal radiographs produced during measurement of colonic transit time (CTT) were classified as constipated or normal based on the value of the transit time, and were scored using both systems by observers blinded to the CTT. Abdominal radiographs obtained in children for reasons other than constipation were classed as normal and similarly scored. Reproducibility was measured using the kappa statistic. Diagnostic accuracy was measured using the area under the curve (AUC) for the receiver operator characteristic (ROC) curve. Results  Using either system, scores were higher for constipated children (P<0.01). The consultant produced higher scores than the other observers (P<0.01). Interobserver reproducibility was moderate with the best kappa value only 0.48. The best correlation between score and CTT was 0.51 (junior doctor scores). Diagnostic accuracy of the scores was only moderate, with the largest AUC for a ROC curve of 0.84 for the consultant using the Barr score. Conclusions  Scoring of abdominal radiographs in the assessment of childhood constipation should be abandoned because it is dependent on the experience of the observer, is poorly reproducible, and does not accurately discriminate between constipated children and children without constipation. This work was presented to the international meeting of the British Association of Paediatric Surgeons.     

Slow transit constipation in children

Patients with chronic constipation that fails to respond to treatment remain a challenge for paediatricians and surgeons. Ongoing work in our institution suggests that a number of children with intractable symptoms have slow transit constipation, which has only been described recently in paediatrics. Common features of slow transit are: delayed passage of the first meconium stool beyond 24 h of age, symptoms of severe constipation within a year, or treatment-resistant 'encopresis' at 2-3 years, soft stools despite infrequent bowel actions, and delay in colonic transit on a transit study. A proportion of children with slow transit constipation have an abnormality of intestinal innervation associated with the dysfunctional colonic motility, recognized as intestinal neuronal dysplasia (IND). Intestinal neuronal dysplasia type B, the most common variant of IND, is defined on rectal biopsy by hyperplasia of the submucosal plexus. On laparoscopic colon muscle biopsy, many specimens show reduced numbers of excitatory substance P-immunoreactive nerve fibres in the circular muscle. Functional markers of the nerves allow new diagnostic criteria to be developed which may also allow a more rational approach to treatment. The aetiology remains obscure and the optimal management poorly defined, although subtotal colectomy, proximal colostomy or appendicostomy (for antegrade enemas) have been tried. Once the anatomy and physiology of the colon in children with slow colonic transit is better understood, we will have defined not only a new form of constipation, but also will be able to consider new therapies.     

Total and segmental colonic transit time and anorectal manometry in children with chronic idiopathic constipation

BACKGROUND: Constipation is a frequent symptom in pediatric clinical practice, although the underlying pathogenesis is not fully understood. Estimating the colonic transit time may help identify subgroups of patients with different physiopathologic mechanisms. METHODS: Thirty children with normal bowel habits and 38 children with chronic idiopathic constipation, aged 2 to 14 years, were studied. The total and segmental colonic transit times were estimated by administering multiple radiopaque markers for 6 days and performing a single abdominal radiograph on day 7. Anorectal function was evaluated using manometry with an Arhan probe. RESULTS: The observed upper reference values were 19.02 hours for the right colon, 19 hours for the left colon, 32 hours for the rectosigmoid colon, and 45.7 hours for the total colon. Fifty percent of the children with chronic idiopathic constipation had colonic transit times within reference values, whereas 37% had left colonic and rectosigmoid delays and 13% had global delay in all colonic segments (colonic inertia). Paradoxic anal contraction was observed in 64% of the constipated children with distal delay but in none of the subjects with colonic inertia. CONCLUSIONS: Estimating colonic transit time is a simple and noninvasive technique for classifying patients with constipation. Colonic inertia may be a manifestation of global motility dysfunction. Children with delayed distal colonic transits are more likely to have abnormal defecation dynamics.     

Long-term functional results following resection of neonatal sacrococcygeal teratoma

Purpose  Sacrococcygeal teratoma (SCT) is the most common congenital neoplasm in neonates. We wished to assess the long-term functional outcome of children undergoing SCT resection. Methods  Records of neonates diagnosed with SCT from two surgeons’ practices, and operated on between 1970 and 2006, were retrospectively reviewed. Patients/parents who consented to participate in the study received a questionnaire, focusing on fecal and urinary continence, constipation and lower extremity weakness. Results  Forty-six patients were identified. Four had died (3 from malignant tumors and 1 motor vehicle accident at 18 years). Of the 42 remaining cases, 39 were benign and 3 were malignant; 2 of the former developed malignant recurrences. Twenty-seven agreed to participate and 14 (52%) completed the questionnaire. Median age of respondents was 16.7 years (3–29), and none of the respondents had a recurrent tumor. Thirteen of the 14 respondents experienced no problem with urinary or fecal incontinence, or lower extremity weakness. The remaining patient had all three problems, but his SCT had involved the spinal cord. Of the ten patients who commented on constipation, one had significant constipation, five occasional constipation, and four no constipation. Conclusions  Functional results after resection of neonatal SCT are excellent, with only a small number of patients reporting problems with fecal or urinary continence, or lower extremity weakness. Constipation is relatively common. This information is important for counseling families with fetal or neonatal SCT.