Diagnostic Accuracy of Recto-Sigmoid Index Evaluation on Barium Enema in Hirchsprung’s Disease

Abstract

Background: Hirschsprung’s disease is a congenital disease caused by the absence of ganglion cells in the bowel wall, which results in functional obstruction of the aganglionic segment due to failure of relaxation during peristalsis. The recto-sigmoid index on barium enema may constitute in the diagnosis of Hirschsprung’s disease. Aim: To evaluate the sensitivity, specificity, positive predictive value, and negative predictive value of recto-sigmoid index for the diagnosis of Hirschsprung’s disease in patients who underwent barium enema examination. Methods: This retrospective study was conducted in Dr Soetomo Hospital. Medical records of patients suspected of Hirscsprung’s disease who underwent both barium enema examination and diagnostic full thickness biopsy were evaluated. Moreover, the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of recto-sigmoid index was calculated. Results: A total of 37 patients were examined; 21 of them were male. The average age was 24.5 (SD 17.34, range 1 month-72 month). Biopsy revealed the absence of ganglion cells in 32 (91,8%) patients. The rectosigmoid index agreed with the histopathologic diagnosis in 30 (81%.) patients. The sensitivity, specificity, PPV, and NPV were 87.5%, 40%, 90.5% and 33% respectively. Conclusion: Recto-sigmoid index evaluation in barium enema for the diagnosis of Hirscsprung’s disease has poor diagnostic accuracy.