DIAGNOSTIC ACCURACY OF BARIUM ENEMA FINDINGS IN HIRSCHSPRUNG'S DISEASE.

Mehran Peyvasteh,Mohammad-Reza Moghimi,Nasrollah Ostadian,Shahnam Askarpour,Hazhir Javaherizadeh

doi:10.1590/0102-6720201600030007

Abstract

ABSTRACTBackground: Hirschsprung's disease is the most common cause of pediatric intestinal obstruction. Contrast enema is used for evaluation of the patients with its diagnosis. Aim: To evaluate sensitivity, specificity, positive predictive value, and negative predictive value of radiologic findings for diagnosis of Hirschsprung in patients underwent barium enema. Methods: This cross sectional study was carried out in Imam Khomeini Hospital for one year starting from 2012, April. Sixty patients were enrolled. Inclusion criteria were: neonates with failure to pass meconium, abdominal distention, and refractory constipation who failed to respond with medical treatment. Transitional zone, delay in barium evacuation after 24 h, rectosigmoid index (maximum with of the rectum divided by maximum with of the sigmoid; abnormal if <1), and irregularity of mucosa (jejunization) were evaluated in barium enema. Biopsy was obtained at three locations apart above dentate line. PPV, NPV, specificity , and sensitivity was calculated for each finding. Results: Mean age of the cases with Hirschsprung's disease and without was 17.90±18.29 months and 17.8±18.34 months respectively (p=0.983). It was confirmed in 30 (M=20, F=10) of cases. Failure to pass meconium was found in 21(70%) cases. Sensitivity, specificity, PPV, and NPV were 90%, 80%, 81.8% and 88.8% respectively for transitional zone in barium enema. Sensitivity, specificity, PPV, and NPV were 76.7%, 83.3%, 78.1% and 82.1% respectively for rectosigmoid index .Sensitivity, specificity, PPV, and NPV were 46.7%, 100%, 100% and 65.2% respectively for irregular contraction detected in barium enema. Sensitivity, specificity, PPV, and NPV were 23.3%, 100%, 100% and 56.6% respectively for mucosal irregularity in barium enema. Conclusion: The most sensitive finding was transitional zone. The most specific findings were irregular contraction, mucosal irregularity, and followed by cobblestone appearance.

Highlights

Hirschsprung’s disease (HD) is a common cause of pediatric intestinal obstruction[9]
Inclusion criteria were: neonates with delayed meconium passage and clinical symptoms of Hirschsprung; and children with refractory constipation who failed to respond with medical treatment
Barium enema was done under supervision of experienced radiologists who are familiar with pediatric radiology

Summary

Introduction

Hirschsprung’s disease (HD) is a common cause of pediatric intestinal obstruction[9]. It is caused by the failure of the ganglion cells to migrate cephalocaudally through the neural crest causing absence of ganglion cell in all or some parts of colon[1]. Hirschsprung’s disease was reported as the etiology of childhood bowel obstruction in about 12% of cases in our country[15]. In another study from Nigeria, it is the etiology of intestinal obstruction in children with a frequency. Rectal suction biopsy, and barium enema are used in our country. Anorectal manometry is not available in many hospitals. Barium enema (BE) is available in many centers even without pediatric surgeon

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