BARIUM ENEMA: IS IT IMPORTANT IN THE EVALUATION OF CHILDHOOD CONSTIPATION

Abstract

We question the importance of barium enema (BE) in the evaluation of childhood constipation. The radiographic appearance of a transition zone (TZ) or delayed evacuation of barium (DEB) on BE necessitates a second procedure, rectal suction biopsy (RSB). RSB is performed to confirm the presence of submucosal ganglion cells and rule out Hirschsprung's disease (HD). To determine if RSB alone is sufficient to evaluate the child with constipation, we retrospectively reviewed the charts of 76 children (1day-18yrs) with constipation who had BE & RSB. BE were reviewed for TZ, DEB and/or other colonic anatomic abnormalities (CAA). Seven children (9%) had CAA; 5 neonates (under 1 wk of age) with microcolon and 2 infants with previous history of NEC had colonic strictures. TZ was present in 23 patients (30%) and DEB in 26 patients (34%). Results of RSB are presented below: DEB is an unreliable radiographic sign for the diagnosis of HD; 77% of these children had normal RSB. In addition, the presence of a TZ is nondiagnostic of HD. Eleven (48%) children with suspected TZ had ganglion cells present on RSB. Three children with normal BE had no ganglion cells on RSB. A normal BE does not rule out HD. Therefore, infants over 7 days of age who have constipation and no previous NEC history or signs of intestinal obstruction can be adequately screened for HD by RSB without BE.