The value of the 24-h delayed abdominal radiograph of barium enema in the diagnosis of Hirschsprung's disease.

Abstract

The objective of this study is to determine the diagnostic value of the 24-h delayed film for Hirschsprung's disease (HD). Other features of the barium enema were also examined, in particular the correlation between the radiological transition zone (TZ) and the final pathology. All patients with suspected HD from 2003 to 2013 who had undergone barium enema and rectal biopsy were reviewed retrospectively to study the correlation between radiological features of barium enema with the final diagnosis as well as severity. A total of 182 patients were admitted for suspected HD during the study period, of which 82 had both investigations done. 68 patients had radiological features suggestive of the disease and ultimately, 12 patients had the disease confirmed with rectal biopsy. Among those without radiological features of HD, 2 patients were found to have the disease. Thus, the sensitivity of the 24-h delayed film was 85.7% and the specificity was 17.6%. The positive predictive value (PPV) of this test was 20.6% and the negative predictive value (NPV) was 85.7%. Regarding the level of TZ, it was not detected in the barium enema in 7 (50%) out of the 14 patients. For those with the presence of TZ, 6 (85.7%) of them correlated well with the intra-operative findings and 4 (57.1%) of them correlated well with the final histology. The 24-h delayed film of barium enema has a high NPV and is useful to rule out HD. However, rectal biopsy is still suggested for disease confirmation given its low PPV. Lastly, once present, the level of radiological TZ is also a useful predictor for the actual disease involvement.