![]() Such unwarranted referrals expose the patients to unnecessary risks and discomforts and put a strain on an already over-stretched healthcare resources. Since diarrheal states are much more common than CRC, in the absence of authentic symptomatology of CRC, such as rectal bleeding, change in the bowel habit, tenesmus, left-sided abdominal cramps, anemia, etc., the referral of these patients for colonoscopy based solely on "decreased stool caliber" is unwarranted. After surgery, most children are able to pass stool through the anus. Our own everyday experience shows that low caliber stool is noticed whenever we have loose stool. In the absence of ganglion cells, the bowel tonically contracts causing functional intestinal obstruction. Nevertheless, this misconception somehow permeated the standard textbooks of medicine and even the newer editions of text-books of gastroenterology. Hirschsprung disease (HSCR), the most well-understood intestinal motility disorder, is characterized by the complete absence of enteric neurons (i.e., aganglionosis) in the myenteric and submucosal plexus of the distal bowel. narrow distal segment with a sharp transition to the. ![]() In the absence of reliable data to support this concept, the authors of gastroenterology textbooks in the mid-twentieth century practically dismissed the concept. Most children with Hirschsprung disease do not pass stool in the first 24 hours of their life. ![]() presence of tumor results in narrowing of the colon, which in turn decreases the caliber of the stool-was conceived late in the nineteenth century. A review of the literature reveals that this rather lay misconception-i.e. Over the past several years, primary care providers have been referring a large number of their patients to gastroenterologists for colonoscopy because of 'low caliber stool' or 'pencil thin stool.' Most textbooks of internal medicine and gastroenterology consider 'small caliber stool' as one of the presenting signs of colorectal cancer (CRC). Besides narrow stools, other symptoms of anal stenosis are. Over the past several years, primary care providers have been referring a large number of their patients to gastroenterologists for colonoscopy because of "low caliber stool" or "pencil thin stool." Most textbooks of internal medicine and gastroenterology consider "small caliber stool" as one of the presenting signs of colorectal cancer (CRC). Other causes of anal stenosis are chronic diarrhea, long-term laxative use, trauma, radiotherapy, tuberculosis, and other infections.
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