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196 Chapter 9 peristaltic contractions, which are of key importance in the antegrade mass movement of feces and play an important role in defecation. 18 These contractions are therefore considered to be an essential parameter of normal colonic motility. The aim of our study was to describe the association between findings on contrast enemas and colonic manometry in children with severe intractable FC to determine if there is a relationship between colonic dilation or elongation and colonic dysmotility. Our primary aim was to determine if the colonic diameter differs between colonic segments with HAPCs and those without HAPCs. Our secondary aim was to compare the colonic diameter between children with normally propagating HAPCs and children with incomplete HAPCs, which terminate prematurely, before reaching the recto-sigmoid junction. Our tertiary aim was to compare colonic diameter and length in children with FC with those from a normative population and with predefined reference values for megacolon/megarectum. METHODS Subjects For this retrospective chart review, we identified children with intractable FC (according to the Rome III criteria and the ESPGHAN/NASPGHAN guideline on functional constipation in children) in whom colonic manometry and contrast enema were performed between June 1, 2010 and March 1, 2016 at Nationwide Children's Hospital (Columbus, OH, USA). Children were eligible for inclusion if the following criteria were met: (i) 0-18 years of age at the time of colonic manometry and contrast enema study; (ii) diagnosis of FC according to the Rome III criteria and a history of FC ≥2 years; (iii) colonic manometry and contrast enema performed within 12 months from each other. Exclusion criteria were: (i) organic causes of constipation (e.g., Hirschsprung's disease, anorectal malformations, hypothyroidism, spina bifida); (ii) surgery involving the luminal distal gastrointestinal tract with the exception of appendectomy (e.g., cecostomy, appendicostomy, colonic resection, ileostomy, colostomy, pull-through surgery); (iii) sacral nerve stimulator present at the time of colonic manometry; (iv) proximal placement of the colonic manometry catheter preventing evaluation of the most distal 20 cm of the colorectum; (v) absent rectoanal inhibitory reflex on anorectal manometry; (vi) incomplete data for interpretation of colonic manometry/contrast enema; (vii) inability to perform the required measurements on contrast enemas (e.g., inability to perform calibration or incomplete visualization of colonic structures).