How Useful is Contrast Enema in the Diagnosis of Hirschsprung’s Disease? Five-year Experience from a Local Referral Centre

Abstract

Objective: To review the diagnostic performance of contrast enema examinations for the investigation of Hirschsprung’s disease, determine the usefulness of delayed 24-hour X-rays, and validate water-soluble contrast enemas for the investigation for patients with suspected Hirschsprung’s disease. Methods: This was a retrospective study of all neonates and infants referred for radiological evaluation of symptoms and signs suspicious of Hirschsprung’s disease in Queen Mary Hospital, Hong Kong from January 2007 to December 2011. Patients were included in this study when all radiographs were available and Hirschsprung’s disease had been confirmed or excluded by rectal biopsy or by a combination of enema results, manometry, and close clinical follow-up. Radiographs and reports were reviewed with a checklist of radiological criteria described in the literature, including transitional zone, rectosigmoid index (maximum width of rectum divided by maximum width of sigmoid; abnormal if <1), irregular contractions, mucosal irregularity, spasm, serrations and retention of contrast agent on delayed radiographs. The sensitivity, specificity, positive and negative predictive values of each of these criteria were calculated and considered in the context of recommendations described in the literature. Results: A total of 136 such patients were evaluated during the study period, of whom 86 had barium enemas and 57 had water-soluble contrast enemas. Among all the patients reviewed, the sensitivity, specificity, positive and negative predictive values for all enema examinations (excluding delayed films) in the diagnosis of Hirschsprung’s disease were 69%, 89%, 44% and 96%, respectively. While the corresponding values of all enema examinations (including delayed films) were 100%, 78%, 36% and 100%, respectively. Similar results were noted in patients having barium enemas and water-soluble contrast enema examinations. For patients having barium enemas or water-soluble contrast enemas, with the inclusion of delayed films there was a significant increase in sensitivity compared to sensitivity derived without recourse to delayed films, whilst there was only a slight reduction in specificity. Conclusion: Recourse to water-soluble contrast enemas with the addition of a 24-hour delayed film was useful in the diagnosis of Hirschsprung’s disease.