Validity of Barium Enema as Hirschsprung’s Disease Diagnostic Tools for Infant in Sanglah Hospital Denpasar

Abstract

Aim: To determine the validity (sensitivity, specificity, likelihood ratio) of barium enema as Hirschsprung's disease diagnostic tool in infants. Methods: This study was a diagnostic test of barium enema compared with postoperative histopathology examinations as the gold standard. The population were all patients with indigestion symptom be discovered at the pediatric surgical clinic of Sanglah Hospital Denpasar. The sampling method was consecutive sampling, satisfy inclusion criteria (< 12 months old, indicate classic symptoms of Hirschsprung’s disease). The total sample of the study was 52 patients. Sensitivity, specificity, positive and negative predictive value were analysed using cross-tabulation test of barium enema and postoperative histopathology. Results: A total of 52 patients were evaluated during the study period, mean of age was 3.31 months old, and boys:girls (75%:25%). Based on symptoms, 98.08% of patients were delayed release of meconium more than 24-48 hours and abdominal distention. Among all the patients reviewed, sensitivity, specificity, positive and negative predictive value of barium enema for diagnostic of Hirschsprung’s disease was 95.5%, 87.5%, 97.7%, and 77.8%. Conclusion: Barium enema can be used as an early diagnostic tool for infants suspected of Hirschsprung’s disease.

Diagnostic accuracy of barium enema versus full‐thickness rectal biopsy in children with clinically suspected Hirschsprung's disease: A comparative cross‐sectional study

“…6,15,16 The Sn, Sp, and accuracy of barium enema in the diagnosis of HSD in this study was 0.95 (0.81-0.99), 0.72 (0.39-0.94), and 0.84 (0.69-0.98), respectively, similar to reports from Indonesia and Taiwan. 9,18 The wider CIs can be attributed to the small sample size of our study. The diagnostic accuracy of BE was found to be high in neonatal age groups, approaching 100%.…”

“…One possible explanation for the observed difference could be that the previous studies did not include a proportional number of neonates, which may have biased the comparison. Another reason might be related to the common method of barium enema examination using 24‐h delayed abdominal radiographs in studies reporting higher rates 7,9 . However, newborns were still underrepresented in our study, and we did not take a 24‐h delayed BE film.…”

“…Another reason might be related to the common method of barium enema examination using 24-h delayed abdominal radiographs in studies reporting higher rates. 7,9 However, newborns were still underrepresented in our study, and we did not take a 24-h delayed BE film.…”

“…The presence of a transition zone (TZ) with proximally dilated bowel, abnormal rectosigmoid ratio (less than 1), irregular contractions of the colon, mucosal irregularities, and retention of contrast medium on the film after voiding are the major findings indicative of HSD 4 . These can have an Sn and Sp between 40% and 80% 4,8,9 . Some signs, such as the presence of a transition point, may not be obvious in early presentations.…”

“… 4 These can have an Sn and Sp between 40% and 80%. 4 , 8 , 9 Some signs, such as the presence of a transition point, may not be obvious in early presentations. Thus, studies question their relevance in infants under the age of 6 months.…”