Hirschsprung disease: accuracy of the barium enema examination.

Abstract

To determine the relative accuracy of the various radiologic signs of Hirschsprung disease (HD), we retrospectively reviewed both radiographs obtained after a barium enema and the medical records of 62 children who had surgery to prove or exclude the diagnosis of HD. The visualization of a rectosigmoid transition zone was highly predictive of HD, but nonvisualization did not rule out HD. A false positive transition zone at the splenic flexure was seen in four neonates who had small left colon syndrome rather than HD. Retention of barium seen on radiographs obtained 24 hours after a barium enema was not a specific sign, but it was the only sign of HD in seven neonates, including two who had total colonic aganglionosis. Anal manipulation prior to the barium enema examination did not affect the diagnostic value of that procedure. We conclude that the single most reliable radiographic sign of HD is the presence of a rectosigmoid transition zone. Statistically, the use of three radiographic features combined (rectosigmoid transition zone, retention of barium, and stool mixed with barium) correlated better with the presence or absence of HD than did any of these features alone. A comparison of 24 and 48 hour postevacuation radiographs may help to differentiate HD from meconium plug syndrome.

Evaluation of suspicious Hirschsprung disease in children using radiologic investigation method: a prospective observational study

“…A delay in passage of meconium is the most pertinent observation in the neonate suspected of having HD (80%). 31 In the present study we had observed abdominal distension, lack of meconium defecation, and constipation were the most common clinical symptoms with frequencies of 15 (78.9%), 11 (57.8%), and 14 (73.68%) respectively. Whereas normal babies pass meconium within 24 hours, and even up to 48 hours, any baby who passes no or little meconium even after 24 hours should be investigated for HD.…”

Role of anorectal manometry in the differential diagnosis of chronic constipation in children

“…Idade ( O enema baritado para diagnóstico do megacolo congê-nito aganglionar tem sido considerado um instrumento pouco preciso no recém-nascido, quando a aganglionose é total e nas formas de acometimento ultracurto [7][8][9] . Num grupo de 58 crianças constipadas, a presença da zona de transição no retosigmóide, rotineiramente associada à aganglionose, foi identificada em 9 crianças com constipação funcional.…”

“…Da mesma forma que o enema baritado, a manometria anorretal não apresenta 100% de acurácia para o diagnós-tico diferencial [5][6][7][8][9] , identificando-se resultados falsos negativo 10-11 e falsos positivos [12][13][14] . Na última década, os dados da literatura têm registrado uma confiabilidade variável da manometria na identificação da doença de Hirschsprung e das displasias neuronais [15][16][17][18] .…”

Pediatrik Abdomende Kontrastli Radyografi

“…Olguların %65'inde geçiş zonu rektosigmoid bölgededir (Resim 4). Agangliyonik segmentin proksimalinde kolon EĞİTİCİ NOKTA EĞİTİCİ NOKTA segmentleri ve ince bağırsaklar dilatedir [16]. Total aganglionozis ve çok kısa segment hastalıkta tanı güç olup baryumlu inceleme normal olabilir [17].…”