Colon Length in Children, Normal Values Based on Magnetic Resonance Imaging

Colon Length in Children, Normal Values Based on Magnetic Resonance Imaging | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Colon Length in Children, Normal Values Based on Magnetic Resonance Imaging Charlotte Anne Louise Jonker, Ramon R Gorter, Marc A Benninga, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7103714/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Currently, dolichocolon and dolichosigmoid lack objective definitions. As a result, diagnoses rely on subjective clinical judgment, though these conditions significantly impact decision making in children with therapy-resistant constipation. Objective To establish normative data on colon lengths in children without constipation using a three-dimensional multiple-point measurement (3D MPM) technique on magnetic resonance imaging (MRI. Methods This retrospective study included children aged 0–17 years who underwent MRI enterography in 2016 or 2020 for suspected inflammatory bowel disease (IBD) but did not meet Rome IV criteria for functional constipation. Patients with colonic inflammation on MRI or endoscopy were excluded. Primary outcome was the mean total colon length (± 2SD); secondary outcome was the mean rectosigmoid length (± 2SD). Two authors independently measured colon segments on coronal T2-weighted MRI using 3D MPM in syngo.via VB60S_HF90 (Siemens Healthineers). Linear regression was used to evaluate associations with age, height, weight, and body surface area (BSA). Results Eighty-one children (median age 15 years; range 11–17; 53% male) were included. Mean total colon length was 115.8 ± 13.8 cm; mean rectosigmoid length was 38.2 ± 7.9 cm. Colon length significantly correlated with age (p = 0.03), height (p < 0.001), weight (p < 0.001), and BSA (p < 0.001). Conclusion This study offers normative data on colon and rectosigmoid lengths in children without constipation. These values may serve as reference standards for diagnosing dolichocolon and dolichosigmoid in children with therapy-resistant constipation. Pediatrics Magnetic resonance imaging Constipation Dolichocolon Dolichosigmoid Figures Figure 1 Figure 2 Introduction Constipation in children is a global problem, with a pooled prevalence of 8.17% (95% CI: 6.33%-10.22%) for children from 0 to 4 years old and 11.39% (95% CI: 9.34%-14.11%) for children 4-18 years old [1]. According to the pediatric Rome IV criteria, functional constipation (FC) is defined as the presence of two or more of the following symptoms for at least one month in children aged four years and older: 1) fewer than three bowel movements per week, 2) at least one episode of fecal incontinence per week, 3) history of excessive stool retention, 4) history of painful or hard bowel movements, 5) presence of a large fecal mass in the rectum, and 6) large-diameter stools that may obstruct the toilet [2,3]. Initial treatment for constipation involves both non-pharmacological and pharmacological approaches [4]. Despite optimal conservative treatment, some children continue to experience infrequent defecation and fecal incontinence, recently defined as therapy-resistant constipation [5]. Indeed, studies have shown that half of the children referred to a pediatric gastroenterologist for constipation are still symptomatic 5 years after intensive oral and/ or rectal laxative treatment and about 20% continue to struggle with this problem 10 years later [6]. In a minority of such cases, more invasive treatments, such as surgery, may be considered. To guide surgical decision-making, imaging studies, such as contrast studies can be used to provide information on the anatomy of the large bowel and help identify conditions such as dolichocolon or dolichosigmoid, referring to a significantly elongated or dilated colon [7-9]. Currently, there is a lack of objective definitions for dolichocolon and dolichosigmoid. As a result, the diagnoses of dolichocolon and/or dolichosigmoid are based on individual experience and are subjective by nature but are of great importance in clinical decision making for children with therapy resistant constipation. To establish reference values for the colon and rectosigmoid in otherwise healthy children aged 0–18 years to better identify a dolichocolon and a dolichosigmoid, more measurements are needed. Therefore, we aimed to provide normative data on colon and rectosigmoid lengths in children without constipation using a multiple-point measurement (MPM) technique on MRI. Materials & Methods Study design & population This retrospective study was performed in a tertiary children’s hospital. All children who underwent abdominal MRI enterography (MRE) between 2016 and 2020 because of suspicion of inflammatory bowel disease (IBD), were eligible for inclusion. Children were excluded if: (1) their colon was affected by IBD as seen on MRI or scopy, such as colonic wall thickening, as this could potentially affect normal colonic anatomy, endoscopy or pathology report, as this could potentially affect normal colonic anatomy; (2) they fulfilled the diagnosis of functional constipation as defined by the Rome IV criteria; (3) there was inability to perform the required measurements on the imaging files (e.g., poor quality of series or incomplete imaging); (4) they were ≥18 years at the time of the MRI; (5) age categories including fewer than five patients or (6) no informed consent was provided. Magnetic Resonance Imaging All children underwent an abdominal MRE because of suspicion of IBD. This protocol included a coronal t2 TRUFI with breath hold covering the whole abdomen, slice thickness 3 to 5 mm slice thickness, depending on size of the patient (figure 1). Patients were scanned on a 1.5 T Magnetom Avanto (Siemens, Erlangen, Germany). The patients were imaged in the supine position using a breath-hold technique. Patients were required to take oral contrast before the MRI to enhance visualization of the ileum. In most patients only a small amount, or no oral contrast reached the colon. An MRE takes a total scanning time of approximately 30 minutes. Image analysis All eligible MRI images were imported into the software syngo. via VB60S_HF90 (Siemens Healthineers, Forchheim, Germany) [10]. Colon length was assessed using a multiplanar reconstruction mode (MPR), a technique for visualizing 3D datasets that allows the generation of sectional images, including coronal, sagittal, and oblique images. (figure 2) Total colon length was defined as the sum of predetermined colonic segments, measured as follows: Rectosigmoid: from the anal canal to the cross-over of the iliac veins; Descending colon: from the cross-over of the iliac veins to the splenic flexure, where the colon enters the retroperitoneum; Transverse colon: from the splenic flexure to the hepatic flexure, where the colon exits the retroperitoneum; Ascending colon: from the hepatic flexure to the end of the cecum. Measurements of colonic segment lengths were conducted on a coronal plane using a distance polyline tool. This tool allows manual placement of multiple points to calculate segment lengths in cm. The measurements were made by two of the authors independently, an MD, researcher in pediatric surgery and gastroenterology (C.A.L.J.), and a pediatric radiologist (J.S., 12 years of experience). Prior to the measurements, the researcher received training from the pediatric radiologist on how to assess the MRI by measuring 20 cases together. When the measurements differed by more than 10%, the measurement was repeated together. Outcomes The primary outcome was the mean total colon length in cm (95% CI: ± 2SD) and the secondary outcome was the rectosigmoid length in cm (95% CI: ± 2SD). Data management and analysis Categorical variables were presented as frequencies and percentages and non-parametric continuous variables were presented as median and interquartile ranges (IQR, 25th and 75th percentiles). The Shapiro-Wilk normality test was used to test the normality of the data. Linear regression was used to explore the relationship between colon lengths and age, height, weight and body surface area. Statistics were performed using R, version 2023.03.1.446. Ethical considerations This study complies with the Declaration of Helsinki. As this retrospective study was not subject to the Medical Research Involving Human Subjects Act, approval from an ethics committee in the Netherlands was not required. This was confirmed by the ethical committee in our center (reference number: 2024.0568). Children eligible for inclusion were informed about the current study via an information letter and informed consent from either the child (if 16 years or older) and/or their parents was obtained prior to data collection. Results We identified 112 children who underwent abdominal MRE for IBD at our center. Thirty-one patients (28%) were excluded from analysis due to the following reasons: adulthood at the time of the MRE (N=1), a diagnosis of constipation (N=2), a colon affected by IBD (N=20). Additionally, age categories of 6 (n=2), 9 (n=2), and 11 (n=4) years were excluded, as each category included fewer than five patients. This exclusion also ensured a consecutive sequence of age categories. Consequently, 81 patients were included with a median age of 15 years (range 11-18 years) of whom (53%) were boys. Overall, the mean total colon length was 115.8 ± 13.8 cm, with a 95% CI of 88.2 to 143.4 cm. The mean rectosigmoid length was 38.2 ± 7.9, with a 95% CI of 22.4 to 54 cm. Table 1 shows the median lengths of predetermined colonic segments per age in years. A linear regression model demonstrated a significant correlation between total colon length and age (p = 0.03), height (p = <0.001), weight (p = <0.001) and body surface area (BSA) (p = <0.001) (table 2). Rectosigmoid length did not correlate significantly with age (p = 0.86), height (p = 0.87), weight (p = 0.50) and BSA (p = 0.46) (table 3). The interobserver variability was 11/81 (14%). The main differences were observed in the rectosigmoid segment. Discussion Using a 3D MPM technique we measured the lengths of predefined colonic segments in children aged 11–18 years undergoing abdominal MRE for IBD, excluding those with a history of constipation. The mean total colon length was 115.8 ± 13.8 cm (95% CI: 88.2–143.4 cm), and the mean rectosigmoid length was 38.2 ± 7.9 cm (95% CI: 22.4–54.0 cm). Total colon length was significantly correlated with age, height, weight, and BSA. Without reference values or a definition of what normal length and width of the colon and rectosigmoid for different age groups are, it remains difficult to define a dolichocolon or dolichosigmoid. Acquiring normative data in children is challenging, particularly in clinical studies involving healthy children. These studies are difficult to conduct, especially when they impose a physical or emotional burden on the child. This challenge extends to studies involving radiation exposure, and enteral contrast. For this reason, we chose to retrospectively evaluate children with IBD, who had already undergone an abdominal MRE in our hospital. As a result, we were able to include 81 children in our study, a relatively large sample compared to cohorts reported in the current literature. The limited data on colon lengths in (healthy) children, along with differences in the assessed cohorts such as variations in colon physiology due to bowel preparations and the use of contrast enemas, make it challenging to directly compare our findings with earlier studies. Nonetheless, our findings on total colon length are consistent with those of a retrospective study that employed a 3D skeletonization technique to measure colon length from MRI images in 19 healthy children aged 10–18 years [11]. That study reported significant correlations between total colon length and age (R = 0.45, p = 0.0064), height (R = 0.49, p = 0.0031), and weight (R = 0.46, p = 0.0059). In contrast to our study, a previous retrospective study involving 119 children found that the ratios of the diameters and lengths of predetermined colonic segment lengths did not change significantly with age [12]. In this study, evaluation of colon length and width was done on an AP plain radiograph after enteral contrast. Overprojection and lack of three-dimensional resolution may have led to an underestimation of true colon length, and the presence of contrast itself could have affected colonic distention and thus altered segmental dimensions. In contrast to our findings on rectosigmoid lengths, a retrospective study of 112 children aged 0-11 years, using computed tomography, reported a significant correlation between rectosigmoid length and age [13]. Similarly, another retrospective study involving 119 healthy children, which utilized air contrast enemas, found a significant correlation between the rectosigmoid/L2 length ratio and age [12]. These differences may be explained by the influence of air enema, where under pressure the colon distends and this may influence length. Our findings demonstrate the feasibility of using MRI as a patient-friendly, non-invasive technique for assessing colonic length in children. A key advantage of this method is that it can be performed without bowel preparation or enteral contrast, thereby minimizing patient burden and avoiding potential alterations to normal colonic physiology. As such, MRI provides a reliable representation of colonic anatomy in a relatively natural state. When applied to high-quality magnetic resonance MRE scans already acquired in clinical practice, this approach offers a practical, low-impact tool for colonic measurement. In this study, we applied an MPM technique to evaluate colon lengths in a relatively large cohort of children without constipation. The MPM technique proved to be both accessible and reproducible, provided that the underlying MRI images were of sufficient quality and not significantly affected by respiratory motion. The method was straightforward to implement across most colonic segments, as evidenced by the minimal differences observed between a relatively inexperienced reader and a specialized pediatric radiologist. Importantly, this approach is well tolerated by children and does not require contrast administration when MRI is performed solely to assess colonic length. These characteristics make it an attractive imaging modality, particularly in children who may otherwise require more invasive or burdensome procedures. Taking together, our results suggest that MRI, in combination with the MPM technique, may serve as a reliable and clinically useful tool for evaluating colonic anatomy. This approach could potentially support diagnostic or surgical decision-making in children with therapy-resistant constipation or suspected colonic abnormalities in future clinical practice. For clinical purposes, the feasibility of MRI as an imaging modality may be limited by its high cost and restricted availability. Although the protocol for answering colon length can be short, without preparation. We acknowledge several limitations of our study. Firstly, as this was the first study to apply the 3D MPM technique, we were limited in measuring the lengths of predefined colonic segments. In this initial study, we focused on assessing colonic length as a first step in exploring the feasibility of this new measurement technique. We did not yet include colonic width measurements, as we aimed to first establish and refine our approach to length assessment. Determining the most accurate and reproducible method for measuring colonic widths remains an important objective and will be the focus of a future study. Furthermore, all colon length measurements were performed without prior bowel preparation. As a result, factors such as colonic collapse posed challenges to obtaining consistent and precise length estimates. Also, MRI procedures require patients to remain still, generally achievable only from the age of six years. For younger children, sedation or anesthesia is required to prevent movement, which limits the availability of MRI imaging for this age group. Consequently, we were unable to provide a complete overview of colon lengths in the pediatric population for all age groups. However, it is worth noting that surgery for the indication of therapy resistant constipation is usually performed at an age older than six years [14]. Furthermore, one of our exclusion criteria is an affected colon by IBD as seen on MRI as this could potentially affect normal colonic anatomy. Although all images were reviewed by an experienced pediatric radiologist (J.S.), affected colons may have been missing, as this is not the most reliable method for assessing colonic inflammation, potentially impacting our results. Additionally, children undergoing abdominal MRE were required to take oral contrast to visualize the ileum, which may have affected colon physiology as oral contrast may increase colon peristalsis. This could potentially lead to an overestimation of our results. Lastly, the interobserver variability in our study was primarily caused by differences in the rectosigmoid length. This difficulty stemmed from the complex structure of the rectosigmoid; convoluted or collapsed loops are easily missed, often resulting in an underestimation of its length. Conclusion We present normative colon length data in a cohort of children without constipation undergoing abdominal MRE, using a novel 3D MPM technique. The mean total colon length was 115.8 ± 13.8 cm, and the mean rectosigmoid length was 38.2 ± 7.9 cm. Total colon length significantly correlated with age, height, weight, and BSA. This technique represents a promising, non-invasive method for assessing colon length without the need for bowel preparation or contrast, making it well suited for clinical use. Our findings may contribute to the identification of dolichocolon or dolichosigmoid in children with therapy-resistant constipation and offer a potential tool to support surgical decision-making. Future studies will focus on optimizing the measurement of colonic widths and defining thresholds for abnormal colonic anatomy, further enhancing the clinical utility of MRI-based colon evaluation in children. Abbreviations BSA body surface area FC functional constipation IBD inflammatory bowel disease MPM multiple-point measurement MRE magnetic resonance enterography MRI magnetic resonance imaging 3D 3 dimensional Declarations Funding Declaration No funding was received for the conduct of this research. Author Contribution C. J. and J. S. wrote the main manuscript text, C. J. prepared all tables and J.S. prepared all figures. All authors reviewed the manuscript. Acknowledgement We would like to express our sincere gratitude to Prof. Dr. Jos Twisk for his invaluable assistance with the statistical analyses in this study. His expert guidance and thoughtful insights significantly contributed to the rigor and quality of our work. References Bloem MN, Baaleman DF, Thapar N et al (2025) Prevalence of functional defecation disorders in European children: A systematic review and meta-analysis. J Pediatr Gastroenterol Nutr 80(4):580–597. 10.1002/jpn3.12437 Epub 2025 Jan 8. PMID: 39775925; PMCID: PMC11959110 Hyams JS, Di Lorenzo C, Saps M et al (2016) Functional disorders: children and adolescents. Gastroenterology 150(6):1456–1468e2. https://doi.org/10.1053/j.gastro.2016.02.015 Benninga MA, Faure C, Hyman PE et al (2016) Childhood functional gastrointestinal disorders: neonate/toddler. Gastroenterology 150(6):1443–1455e2. https://doi.org/10.1053/j.gastro.2016.02.016 Vriesman MH, Koppen IJN, Camilleri M et al (2020) Management of functional constipation in children and adults. Nat Rev Gastroenterol Hepatol 17(1):21–39. https://doi.org/10.1038/s41575-019-0222-y Gordon M, Khudr J, Sinopoulou V et al (2024) Osmotic and stimulant laxatives for the management of childhood constipation. BMJ Open Gastroenterol 11:e001337. https://doi.org/10.1136/bmjgast-2023-001337 Tabbers MM, DiLorenzo C, Berger MY et al (2014) Evaluation and treatment of functional constipation in infants and children: evidence-based recommendations from ESPGHAN and NASPGHAN. J Pediatr Gastroenterol Nutr 58(2):258–274. https://doi.org/10.1097/MPG.0000000000000266 Levitt MA, Martin CA, Falcone RA et al (2009) Transanal rectosigmoid resection for severe intractable idiopathic constipation. J Pediatr Surg 44(6):1285–1290. https://doi.org/10.1016/j.jpedsurg.2009.02.049 Siminas S, Losty PD (2015) Current surgical management of pediatric idiopathic constipation: a systematic review of published studies. Ann Surg 262(6):925–933. https://doi.org/10.1097/SLA.0000000000000979 van den Berg MM, Hogan M, Caniano DA et al (2006) Colonic manometry as predictor of cecostomy success in children with defecation disorders. J Pediatr Surg 41(4):730–736. https://doi.org/10.1016/j.jpedsurg.2005.12.018 Siemens Healthineers (2024) syngo.via [software]. Erlangen, Germany: Siemens Healthineers. Accessed 16 Jun 2025. https://www.siemenshealthineers.com/digital-health-solutions/syngovia Sharif H, Hoad CL, Abrehart N et al (2024) Colon length in pediatric health and constipation measured using magnetic resonance imaging and three-dimensional skeletonization. PLoS ONE 19(1):e0296311. https://doi.org/10.1371/journal.pone.0296311 Koppen IJ, Yacob D, Di Lorenzo C et al (2017) Assessing colonic anatomy normal values based on air contrast enemas in children younger than 6 years. Pediatr Radiol 47(3):306–312. https://doi.org/10.1007/s00247-016-3746-0 Mirjalili SA, Tarr G, Stringer MD (2017) The length of the large intestine in children determined by computed tomography scan. Clin Anat 30(7):887–893. https://doi.org/10.1002/ca.22941 Swanson KA, Phelps HM, Chapman WC Jr et al (2024) Surgery for chronic idiopathic constipation: pediatric and adult patients—a systematic review. J Gastrointest Surg 28(2):170–178. https://doi.org/10.1016/j.gassur.2023.12.008 Tables Table 1. Colonic segment lengths as median for the whole group and per age group Overall (n = 81) 11 years (n = 7) 12 years (n = 5) 13 years (n = 9) 14 years (n = 16) 15 years (n = 14) 16 years (n = 15) 17 years (n = 15) Rectosigmoid length (cm) 37.8 [32.3, 44.6] 39.5 [29.3, 42.5] 39.6 [37.8, 41.4] 38.3 [31.1, 42.9] 38.4 [33.1, 44.7] 38.0 [34.8, 45.7] 35.9 [33.8, 39.4] 34.2 [31.3, 44.8] Descending colon length (cm) 24.4 [21.2, 25.9] 21.0 [19.9, 22.0] 22.6 [20.5, 23.1] 21.2 [20.0, 23.0] 25.0 [24.1, 27.4] 25.2 [23.9, 27.0] 24.5 [22.7, 25.4] 24.7 [23.4, 26.9] Transverse colon length (cm) 35.4 [31.1, 39.1] 32.1 [30.1, 34.0] 30.1 [29.8, 32.9] 35.2 [32.6, 38.3] 37.1 [32.6, 39.9] 36.5 [31.8, 40.1] 36.4 [31.2, 39.6] 37.1 [33.1, 38.3] Ascending colon length (cm) 18.1 [14.3, 20.9] 19.4 [14.7, 20.0] 15.3 [14.7, 15.7] 16.2 [12.5, 16.8] 18.0 [15.7, 21.1] 18.2 [14.3, 20.8] 18.2 [13.2, 20.9] 19.9 [17.5, 27.1] Total (cm) 116.6 [106.1, 124.6] 109.8 [94.7, 116.0] 106.1 [102.7, 113.1] 112.7 [105.9, 113.6] 124.1 [112.6, 127.2] 117.3 [114.6, 123.4] 119.7 [102.6,124.2] 120.9 [111.1, 128.3] [interquartile range] Table 2. Linear regression total colon length B (Estimate) (SE) P-value Age 1.78 0.82 0.03 Height 0.49 0.11 <0.001 Weight 0.46 0.10 <0.001 BSA 28.9 5.4 <0.001 Table 3. Linear regression rectosigmoid length B (Estimate) (SE) P-value Age -0.09 0.48 0.86 Height 0.01 0.07 0.87 Weight 0.04 0.06 0.50 BSA 2.70 3.60 0.46 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7103714","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":486784402,"identity":"7f795235-8051-4988-b18d-7f3e71b19905","order_by":0,"name":"Charlotte Anne Louise 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06:54:06","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":718532,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7103714/v1/e1718b44-aac6-4156-bb32-6928dc24eafb.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eColon Length in Children, Normal Values Based on Magnetic Resonance Imaging\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eConstipation in children is a global problem, with a pooled prevalence of 8.17% (95% CI: 6.33%-10.22%) for children from 0 to 4 years old and 11.39% (95% CI: 9.34%-14.11%) for children 4-18 years old [1]. According to the pediatric Rome IV criteria, functional constipation (FC) is defined as the presence of two or more of the following symptoms for at least one month in children aged four years and older: 1) fewer than three bowel movements per week, 2) at least one episode of fecal incontinence per week, 3) history of excessive stool retention, 4) history of painful or hard bowel movements, 5) presence of a large fecal mass in the rectum, and 6) large-diameter stools that may obstruct the toilet [2,3]. Initial treatment for constipation involves both non-pharmacological and pharmacological approaches [4]. Despite optimal conservative treatment, some children continue to experience infrequent defecation and fecal incontinence, recently defined as therapy-resistant constipation [5]. Indeed, studies have shown that half of the children referred to a pediatric gastroenterologist for constipation are still symptomatic 5 years after intensive oral and/ or rectal laxative treatment and about 20% continue to struggle with this problem 10 years later [6]. In a minority of such cases, more invasive treatments, such as surgery, may be considered. To guide surgical decision-making, imaging studies, such as contrast studies can be used to provide information on the anatomy of the large bowel and help identify conditions such as dolichocolon or dolichosigmoid, referring to a significantly elongated or dilated colon [7-9].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eCurrently, there is a lack of objective definitions for dolichocolon and dolichosigmoid. As a result, the diagnoses of dolichocolon and/or dolichosigmoid are based on individual experience and are subjective by nature but are of great importance in clinical decision making for children with therapy resistant constipation.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTo establish reference values for the colon and rectosigmoid in otherwise healthy children aged 0–18 years to better identify a dolichocolon and a dolichosigmoid, more measurements are needed. Therefore, we aimed to provide normative data on colon and rectosigmoid lengths in children without constipation using a multiple-point measurement (MPM) technique on MRI.\u0026nbsp;\u003c/p\u003e"},{"header":"Materials \u0026 Methods","content":"\u003cp\u003e\u003cem\u003eStudy design \u0026amp; population\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThis retrospective study was performed in a tertiary children\u0026rsquo;s hospital. All children who underwent abdominal MRI enterography (MRE) between 2016 and 2020 because of suspicion of inflammatory bowel disease (IBD), were eligible for inclusion.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eChildren were excluded if: (1) their colon was affected by IBD as seen on MRI or scopy, such as colonic wall thickening, as this could potentially affect normal colonic anatomy, endoscopy or pathology report, as this could potentially affect normal colonic anatomy; (2) they fulfilled the diagnosis of functional constipation as defined by the Rome IV criteria; (3) there was inability to perform the required measurements on the imaging files (e.g., poor quality of series or incomplete imaging); (4) they were \u0026ge;18 years at the time of the MRI; (5) age categories including fewer than five patients or (6) no informed consent was provided.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eMagnetic Resonance Imaging\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eAll children underwent an abdominal MRE because of suspicion of IBD. This protocol included a coronal t2 TRUFI with breath hold covering the whole abdomen, slice thickness 3 to 5 mm slice thickness, depending on size of the patient (figure 1). Patients were scanned on a 1.5 T Magnetom Avanto (Siemens, Erlangen, Germany). The patients were imaged in the supine position using a breath-hold technique. Patients were required to take oral contrast before the MRI to enhance visualization of the ileum. In most patients only a small amount, or no oral contrast reached the colon. An MRE takes a total scanning time of approximately 30 minutes.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eImage analysis\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eAll eligible MRI images were imported into the software syngo. via VB60S_HF90 (Siemens Healthineers, Forchheim, Germany) [10].\u003c/p\u003e\n\u003cp\u003eColon length was assessed using a multiplanar reconstruction mode (MPR), a technique for visualizing 3D datasets that allows the generation of sectional images, including coronal, sagittal, and oblique images. (figure 2) Total colon length was defined as the sum of predetermined colonic segments, measured as follows:\u0026nbsp;\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eRectosigmoid: from the anal canal to the cross-over of the iliac veins;\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eDescending colon: from the cross-over of the iliac veins to the splenic flexure, where the colon enters the retroperitoneum;\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eTransverse colon: from the splenic flexure to the hepatic flexure, where the colon exits the retroperitoneum;\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eAscending colon: from the hepatic flexure to the end of the cecum.\u0026nbsp;\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eMeasurements of colonic segment lengths were conducted on a coronal plane using a distance polyline tool. This tool allows manual placement of multiple points to calculate segment lengths in cm.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe measurements were made by two of the authors independently, an MD, researcher in pediatric surgery and gastroenterology (C.A.L.J.), and a pediatric radiologist (J.S., 12 years of experience). Prior to the measurements, the researcher received training from the pediatric radiologist on how to assess the MRI by measuring 20 cases together. When the measurements differed by more than 10%, the measurement was repeated together.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eOutcomes\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe primary outcome was the mean total colon length in cm (95% CI: \u0026plusmn; 2SD) and the secondary outcome was the rectosigmoid length in cm (95% CI: \u0026plusmn; 2SD).\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eData management and analysis\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eCategorical variables were presented as frequencies and percentages and non-parametric continuous variables were presented as median and interquartile ranges (IQR, 25th and 75th percentiles). The Shapiro-Wilk normality test was used to test the normality of the data. Linear regression was used to explore the relationship between colon lengths and age, height, weight and body surface area. Statistics were performed using R, version 2023.03.1.446.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eEthical considerations\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThis study complies with the Declaration of Helsinki. As this retrospective study was not subject to the Medical Research Involving Human Subjects Act, approval from an ethics committee in the Netherlands was not required. This was confirmed by the ethical committee in our center (reference number:\u0026nbsp;2024.0568).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eChildren eligible for inclusion were informed about the current study via an information letter and informed consent from either the child (if 16 years or older) and/or their parents was obtained prior to data collection. \u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eWe identified 112 children who underwent abdominal MRE for IBD at our center. Thirty-one patients (28%) were excluded from analysis due to the following reasons: adulthood at the time of the MRE (N=1), a diagnosis of constipation (N=2), a colon affected by IBD (N=20). Additionally, age categories of 6 (n=2), 9 (n=2), and 11 (n=4) years were excluded, as each category included fewer than five patients. This exclusion also ensured a consecutive sequence of age categories. Consequently, 81 patients were included with a median age of 15 years (range 11-18 years) of whom (53%) were boys.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eOverall, the mean total colon length was 115.8 ± 13.8 cm, with a 95% CI of 88.2 to 143.4 cm. The mean rectosigmoid length was 38.2 ± 7.9, with a 95% CI of 22.4 to 54 cm. Table 1 shows the median lengths of predetermined colonic segments per age in years. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eA linear regression model demonstrated a significant correlation between total colon length and age (p = 0.03), height (p = \u0026lt;0.001), weight (p = \u0026lt;0.001) and body surface area (BSA) (p = \u0026lt;0.001) (table 2). Rectosigmoid length did not correlate significantly with age (p = 0.86), height (p = 0.87), weight (p = 0.50) and BSA (p = 0.46) (table 3).\u003c/p\u003e\n\u003cp\u003eThe interobserver variability was 11/81 (14%). The main differences were observed in the rectosigmoid segment.\u0026nbsp;\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eUsing a 3D MPM technique\u0026nbsp;we measured the lengths of predefined colonic segments in children aged 11–18 years undergoing abdominal MRE for IBD, excluding those with a history of constipation. The mean total colon length was 115.8 ± 13.8 cm (95% CI: 88.2–143.4 cm), and the mean rectosigmoid length was 38.2 ± 7.9 cm (95% CI: 22.4–54.0 cm). Total colon length was significantly correlated with age, height, weight, and BSA.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWithout reference values or a definition of what normal length and width of the colon and rectosigmoid for different age groups are, it remains difficult to define a dolichocolon or dolichosigmoid. Acquiring normative data in children is challenging, particularly in clinical studies involving healthy children. These studies are difficult to conduct, especially when they impose a physical or emotional burden on the child. This challenge extends to studies involving radiation exposure, and enteral contrast. For this reason, we chose to retrospectively evaluate children with IBD, who had already undergone an abdominal MRE in our hospital. As a result, we were able to include 81 children in our study, a relatively large sample compared to cohorts reported in the current literature.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe limited data on colon lengths in (healthy) children, along with differences in the assessed cohorts such as variations in colon physiology due to bowel preparations and the use of contrast enemas, make it challenging to directly compare our findings with earlier studies. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eNonetheless, our findings on total colon length are consistent with those of a retrospective study that employed a 3D skeletonization technique to measure colon length from MRI images in 19 healthy children aged 10–18 years [11]. That study reported significant correlations between total colon length and age (R = 0.45, \u003cem\u003ep\u003c/em\u003e = 0.0064), height (R = 0.49, \u003cem\u003ep\u003c/em\u003e = 0.0031), and weight (R = 0.46, \u003cem\u003ep\u003c/em\u003e = 0.0059). In contrast to our study, a previous retrospective study involving 119 children found that the ratios of the diameters and lengths of predetermined colonic segment lengths did not change significantly with age [12]. In this study, evaluation of colon length and width was done on an AP plain radiograph after enteral contrast. Overprojection and lack of three-dimensional resolution may have led to an underestimation of true colon length, and the presence of contrast itself could have affected colonic distention and thus altered segmental dimensions.\u003c/p\u003e\n\u003cp\u003eIn contrast to our findings on rectosigmoid lengths, a retrospective study of 112 children aged 0-11 years, using computed tomography, reported a significant correlation between rectosigmoid length and age [13]. Similarly, another retrospective study involving 119 healthy children, which utilized air contrast enemas, found a significant correlation between the rectosigmoid/L2 length ratio and age [12]. These differences may be explained by the influence of air enema, where under pressure the colon distends and this may influence length.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eOur findings demonstrate the feasibility of using MRI as a patient-friendly, non-invasive technique for assessing colonic length in children. A key advantage of this method is that it can be performed without bowel preparation or enteral contrast, thereby minimizing patient burden and avoiding potential alterations to normal colonic physiology. As such, MRI provides a reliable representation of colonic anatomy in a relatively natural state. When applied to high-quality magnetic resonance MRE scans already acquired in clinical practice, this approach offers a practical, low-impact tool for colonic measurement.\u003c/p\u003e\n\u003cp\u003eIn this study, we applied an MPM technique to evaluate colon lengths in a relatively large cohort of children without constipation. The MPM technique proved to be both accessible and reproducible, provided that the underlying MRI images were of sufficient quality and not significantly affected by respiratory motion. The method was straightforward to implement across most colonic segments, as evidenced by the minimal differences observed between a relatively inexperienced reader and a specialized pediatric radiologist.\u003c/p\u003e\n\u003cp\u003eImportantly, this approach is well tolerated by children and does not require contrast administration when MRI is performed solely to assess colonic length. These characteristics make it an attractive imaging modality, particularly in children who may otherwise require more invasive or burdensome procedures. Taking together, our results suggest that MRI, in combination with the MPM technique, may serve as a reliable and clinically useful tool for evaluating colonic anatomy. This approach could potentially support diagnostic or surgical decision-making in children with therapy-resistant constipation or suspected colonic abnormalities in future clinical practice.\u003c/p\u003e\n\u003cp\u003eFor clinical purposes,\u0026nbsp;the feasibility of MRI as an imaging modality may be limited by its high cost and restricted availability. Although the protocol for answering colon length can be short, without preparation.\u003c/p\u003e\n\u003cp\u003eWe acknowledge several limitations of our study. Firstly, as this was the first study to apply the 3D MPM technique, we were limited in measuring the lengths of predefined colonic segments. In this initial study, we focused on assessing colonic length as a first step in exploring the feasibility of this new measurement technique. We did not yet include colonic width measurements, as we aimed to first establish and refine our approach to length assessment. Determining the most accurate and reproducible method for measuring colonic widths remains an important objective and will be the focus of a future study. Furthermore, all colon length measurements were performed without prior bowel preparation. As a result, factors such as colonic collapse posed challenges to obtaining consistent and precise length estimates.\u003c/p\u003e\n\u003cp\u003eAlso, MRI procedures require patients to remain still, generally achievable only from the age of six years. For younger children, sedation or anesthesia is required to prevent movement, which limits the availability of MRI imaging for this age group. Consequently, we were unable to provide a complete overview of colon lengths in the pediatric population for all age groups. However, it is worth noting that surgery for the indication of therapy resistant constipation is usually performed at an age older than six years [14].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFurthermore, one of our exclusion criteria is an affected colon by IBD as seen on MRI as this could potentially affect normal colonic anatomy. Although all images were reviewed by an experienced pediatric radiologist (J.S.), affected colons may have been missing, as this is not the most reliable method for assessing colonic inflammation, potentially impacting our results. Additionally, children undergoing abdominal MRE were required to take oral contrast to visualize the ileum, which may have affected colon physiology as oral contrast may increase colon peristalsis. This could potentially lead to an overestimation of our results. Lastly, the interobserver variability in our study was primarily caused by differences in the rectosigmoid length. This difficulty stemmed from the complex structure of the rectosigmoid; convoluted or collapsed loops are easily missed, often resulting in an underestimation of its length.\u0026nbsp;\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eWe present normative colon length data in a cohort of children without constipation undergoing abdominal MRE, using a novel 3D MPM technique. The mean total colon length was 115.8 ± 13.8 cm, and the mean rectosigmoid length was 38.2 ± 7.9 cm. Total colon length significantly correlated with age, height, weight, and BSA.\u003c/p\u003e\n\u003cp\u003eThis technique represents a promising, non-invasive method for assessing colon length without the need for bowel preparation or contrast, making it well suited for clinical use. Our findings may contribute to the identification of dolichocolon or dolichosigmoid in children with therapy-resistant constipation and offer a potential tool to support surgical decision-making.\u003c/p\u003e\n\u003cp\u003eFuture studies will focus on optimizing the measurement of colonic widths and defining thresholds for abnormal colonic anatomy, further enhancing the clinical utility of MRI-based colon evaluation in children.\u0026nbsp;\u003c/p\u003e"},{"header":"Abbreviations ","content":"\u003cp\u003eBSA body surface area\u003c/p\u003e\n\u003cp\u003eFC functional constipation\u003c/p\u003e\n\u003cp\u003eIBD inflammatory bowel disease\u003c/p\u003e\n\u003cp\u003eMPM multiple-point measurement\u003c/p\u003e\n\u003cp\u003eMRE magnetic resonance enterography\u003c/p\u003e\n\u003cp\u003eMRI magnetic resonance imaging\u003c/p\u003e\n\u003cp\u003e3D 3 dimensional\u0026nbsp;\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eFunding Declaration\u003c/p\u003e\u003cp\u003eNo funding was received for the conduct of this research.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eC. J. and J. S. wrote the main manuscript text, C. J. prepared all tables and J.S. prepared all figures. All authors reviewed the manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eWe would like to express our sincere gratitude to Prof. Dr. Jos Twisk for his invaluable assistance with the statistical analyses in this study. His expert guidance and thoughtful insights significantly contributed to the rigor and quality of our work.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eBloem MN, Baaleman DF, Thapar N et al (2025) Prevalence of functional defecation disorders in European children: A systematic review and meta-analysis. 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PLoS ONE 19(1):e0296311. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1371/journal.pone.0296311\u003c/span\u003e\u003cspan address=\"10.1371/journal.pone.0296311\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKoppen IJ, Yacob D, Di Lorenzo C et al (2017) Assessing colonic anatomy normal values based on air contrast enemas in children younger than 6 years. Pediatr Radiol 47(3):306\u0026ndash;312. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s00247-016-3746-0\u003c/span\u003e\u003cspan address=\"10.1007/s00247-016-3746-0\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMirjalili SA, Tarr G, Stringer MD (2017) The length of the large intestine in children determined by computed tomography scan. Clin Anat 30(7):887\u0026ndash;893. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1002/ca.22941\u003c/span\u003e\u003cspan address=\"10.1002/ca.22941\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSwanson KA, Phelps HM, Chapman WC Jr et al (2024) Surgery for chronic idiopathic constipation: pediatric and adult patients\u0026mdash;a systematic review. J Gastrointest Surg 28(2):170\u0026ndash;178. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.gassur.2023.12.008\u003c/span\u003e\u003cspan address=\"10.1016/j.gassur.2023.12.008\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 1. Colonic segment lengths as median for the whole group and per age group\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"1006\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e\u003cem\u003eOverall\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e(n = 81)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e\u003cem\u003e11 years\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e(n = 7)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e\u003cem\u003e12 years\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e(n = 5)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e\u003cem\u003e13 years\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e(n = 9)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e\u003cem\u003e14 years\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e(n = 16)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e\u003cem\u003e15 years\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e(n = 14)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e\u003cem\u003e16 years\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e(n = 15)\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e\u003cem\u003e17 years\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e(n = 15)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e\u003cem\u003eRectosigmoid length (cm)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e37.8\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e[32.3, 44.6]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e39.5\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e[29.3, 42.5]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e39.6\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e[37.8, 41.4]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e38.3\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e[31.1, 42.9]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e38.4\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e[33.1, 44.7]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e38.0\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e[34.8, 45.7]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e35.9\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e[33.8, 39.4]\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e34.2\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e[31.3, 44.8]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e\u003cem\u003eDescending colon length (cm)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e24.4\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e[21.2, 25.9]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e21.0\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e[19.9, 22.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e22.6\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e[20.5, 23.1]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e21.2\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e[20.0, 23.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e25.0\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e[24.1, 27.4]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e25.2\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e[23.9, 27.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e24.5\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e[22.7, 25.4]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e24.7\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e[23.4, 26.9]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e\u003cem\u003eTransverse colon length (cm)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e35.4\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e[31.1, 39.1]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e32.1\u003c/p\u003e\n \u003cp\u003e[30.1, 34.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e30.1\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e[29.8, 32.9]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e35.2\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e[32.6, 38.3]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e37.1\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e[32.6, 39.9]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e36.5\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e[31.8, 40.1]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e36.4\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e[31.2, 39.6]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e37.1\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e[33.1, 38.3]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e\u003cem\u003eAscending colon length (cm)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e18.1\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e[14.3, 20.9]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e19.4\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e[14.7, 20.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e15.3\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e[14.7, 15.7]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e16.2\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e[12.5, 16.8]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e18.0\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e[15.7, 21.1]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e18.2\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e[14.3, 20.8]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e18.2\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e[13.2, 20.9]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e19.9\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e[17.5, 27.1]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e\u003cem\u003eTotal (cm)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e116.6\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e[106.1, 124.6]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e109.8\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e[94.7, 116.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e106.1\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e[102.7, 113.1]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e112.7\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e[105.9, 113.6]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e124.1\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e[112.6, 127.2]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e117.3\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e[114.6, 123.4]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e119.7\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e[102.6,124.2]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e120.9\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e[111.1, 128.3]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003e[interquartile range]\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2. Linear regression total colon length\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u003cem\u003eB (Estimate)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u003cem\u003e(SE)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u003cem\u003eP-value\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u003cem\u003eAge\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e1.78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e0.82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e0.03\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u003cem\u003eHeight\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e0.49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e0.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u003cem\u003eWeight\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e0.46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e0.10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u003cem\u003eBSA\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e28.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e5.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3. Linear regression rectosigmoid length\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" class=\"fr-table-selection-hover\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u003cem\u003eB (Estimate)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u003cem\u003e(SE)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u003cem\u003eP-value\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u003cem\u003eAge\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e-0.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e0.48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e0.86\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u003cem\u003eHeight\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e0.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e0.87\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u003cem\u003eWeight\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e0.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e0.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e0.50\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u003cem\u003eBSA\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e2.70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e3.60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e0.46\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Pediatrics, Magnetic resonance imaging, Constipation, Dolichocolon, Dolichosigmoid","lastPublishedDoi":"10.21203/rs.3.rs-7103714/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7103714/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cb\u003eBackground\u003c/b\u003e\u003c/p\u003e\u003cp\u003eCurrently, dolichocolon and dolichosigmoid lack objective definitions. As a result, diagnoses rely on subjective clinical judgment, though these conditions significantly impact decision making in children with therapy-resistant constipation.\u003c/p\u003e\u003cp\u003e\u003cb\u003eObjective\u003c/b\u003e\u003c/p\u003e\u003cp\u003eTo establish normative data on colon lengths in children without constipation using a three-dimensional multiple-point measurement (3D MPM) technique on magnetic resonance imaging (MRI.\u003c/p\u003e\u003cp\u003e\u003cb\u003eMethods\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThis retrospective study included children aged 0\u0026ndash;17 years who underwent MRI enterography in 2016 or 2020 for suspected inflammatory bowel disease (IBD) but did not meet Rome IV criteria for functional constipation. Patients with colonic inflammation on MRI or endoscopy were excluded. Primary outcome was the mean total colon length (\u0026plusmn;\u0026thinsp;2SD); secondary outcome was the mean rectosigmoid length (\u0026plusmn;\u0026thinsp;2SD). Two authors independently measured colon segments on coronal T2-weighted MRI using 3D MPM in syngo.via VB60S_HF90 (Siemens Healthineers). Linear regression was used to evaluate associations with age, height, weight, and body surface area (BSA).\u003c/p\u003e\u003cp\u003e\u003cb\u003eResults\u003c/b\u003e\u003c/p\u003e\u003cp\u003eEighty-one children (median age 15 years; range 11\u0026ndash;17; 53% male) were included. Mean total colon length was 115.8\u0026thinsp;\u0026plusmn;\u0026thinsp;13.8 cm; mean rectosigmoid length was 38.2\u0026thinsp;\u0026plusmn;\u0026thinsp;7.9 cm. Colon length significantly correlated with age (p\u0026thinsp;=\u0026thinsp;0.03), height (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), weight (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and BSA (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e\u003cp\u003e\u003cb\u003eConclusion\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThis study offers normative data on colon and rectosigmoid lengths in children without constipation. These values may serve as reference standards for diagnosing dolichocolon and dolichosigmoid in children with therapy-resistant constipation.\u003c/p\u003e","manuscriptTitle":"Colon Length in Children, Normal Values Based on Magnetic Resonance Imaging","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-06 08:11:44","doi":"10.21203/rs.3.rs-7103714/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"8b57d7cf-abaa-4fea-ab6b-27a9a5a77b76","owner":[],"postedDate":"August 6th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-11-25T06:53:52+00:00","versionOfRecord":[],"versionCreatedAt":"2025-08-06 08:11:44","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7103714","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7103714","identity":"rs-7103714","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}