DIAGNOSTIC METHODS FOR DOLICHOSIGMA IN CHILDREN: A CONTEMPORARY REVIEW AND PRACTICAL ALGORITHM

Abstract

Dolichosigma (elongation and increased mobility of the sigmoid colon) is a common anatomical finding in children with chronic constipation; however, its clinical significance is heterogeneous. In some patients it represents a normal variant, whereas in others it is associated with impaired colonic transit, megarectum/megasigma, fecal impaction, and episodes of subobstruction. The aim of this work is to systematize contemporary diagnostic methods for dolichosigma in children and to propose a practical diagnostic algorithm, emphasizing the need to exclude organic pathology (primarily Hirschsprung disease) and to phenotype constipation (slow-transit constipation vs evacuation dysfunction). Materials and Methods: a narrative review of clinical guidelines (ESPGHAN/NASPGHAN) and current literature (2014–2025), along with an analysis of diagnostic approaches described in local clinical material. Results: key components include clinical assessment according to Rome IV criteria, identification of “red flags,” contrast enema/contrast irrigography for anatomical verification, and functional testing (anorectal manometry, colonic transit studies, and specialized motility diagnostics) in patients with refractory disease. Conclusion: a rational diagnostic strategy for dolichosigma should follow a stepwise approach—from clinical evaluation to targeted instrumental tests—prioritizing minimization of radiation exposure and mandatory exclusion of Hirschsprung disease in young children or in the presence of “red flags.”