Barium Enema Research Articles

Hirschsprung’s disease: epidemiology, diagnosis, and treatment in a retrospective hospital-based study

Hirschsprung’s disease (HD), or congenital megacolon, is a disease characterized by the absence of ganglion cells in the myenteric (Auerbach’s) and submucosal (Meissner’s) plexuses of the intestine, causing maximum obstruction in neonates. The purpose of this study was to investigate patient characteristics, clinical presentation, investigations, surgical treatment, and outcome. This study is a retrospective study of HD cases. Data obtained from medical records at the institution. Of the 109 with a positive rectal biopsy diagnosis, 91 were patients with this disease. There were more cases in boys than girls with a ratio of 1.37: 1. The patients were grouped into 4 age groups: neonates 29 cases (26.61%); infants/toddlers/young children 55 cases (50.46%); children over 5 years16 cases (14.69%); and teenagers 9 cases (8.24%). The neonates generally presented with abdominal distension, green vomiting, and a history of delayed meconium release, while the toddler, child, and adolescent groups experienced constipation and abdominal distension. Furthermore, from 37 patients (33.94%) that got barium enema examination, the most common transition zone was observed in the rectosigmoid (17 patients, or 45.9%). In addition, The Duhamel procedure was the most frequent pull-through procedure found in our cohort which was performed in 40 patients (36.70%). In conclusion, HD is mostly found in male infants/toddlers/young children with abdominal distention and chronic constipation as common symptoms. The barium enema shows the rectosigmoid as the most common transition zone, while the Duhamel pull-through procedure is the primary definitive operative action performed.

A diagnostic medical physicist’s guide to the American College of Radiology Fluoroscopy Dose Index Registry

A diagnostic medical physicist’s guide to the American College of Radiology Fluoroscopy Dose Index Registry

Dolichocolon Presenting with Bilateral Hydronephrosis in a Neonate

Background Dolichocolon is an inborn anatomic variant of the colon with redundancies often causing constipation and/or volvulus presenting in childhood, adolescence, or adulthood. To the best of our knowledge, this is the first case of dolichocolon presenting in infancy with constipation and bilateral hydronephrosis. Case Presentation. A nineteen-day-old neonate presented to the emergency department with severe constipation and discomfort. During his admission, he developed pyelonephritis, and subsequent ultrasound of the kidneys and bladder showed bilateral hydroureteronephrosis. A barium enema was performed and it showed a dolichocolon. Enemas and lactulose were initiated with good effect on both the constipation as well as the hydronephrosis. Conclusions Dolichocolon in a neonate can cause severe constipation which could also lead to an obstructive nephropathy if untreated. Monitoring of urine flow might be indicated when a neonate presents with severe constipation.

Epidemiology of intussusception among children less than 2 years of age; findings from baseline surveillance before rotavirus vaccine introduction in Myanmar

BackgroundRotavirus vaccine was planned to be introduced in the National Immunization Program of Myanmar in 2020. Reported potential association of a small increased risk of intussusception after rotavirus vaccination in some countries is a major safety concern and it is mandatory to collect baseline information before vaccine introduction. MethodsRetrospective study reviewed medical records of intussusception cases for past 3 years (2015–2018) and prospective, active study was conducted from August 2018 to January 2020 at three tertiary children hospitals where pediatric surgical facility is present. Brighton Level 1 Criteria was used for confirmation of intussusception among children <2 years of age admitted to surgical wards. Demographic, clinical, diagnostic and treatment practices data were collected and descriptive data analysis was performed. ResultsA total of 697 (421 in retrospective and 276 in prospective) confirmed intussusception cases were identified. Majority of intussusception cases (550/697, 78.9%) were observed in the first year of life and most frequent between 5-7 months of age (292/697, 41.9%) with a peak at 6 months (114/697, 16.4%). The most common clinical presentations were vomiting and bloody diarrhea accounting 82.1% and 77.5% respectively. Regarding diagnosis and treatment, 458/697 (65.7%) required surgical intervention either manual reduction or intestinal resection and 34.4% by either air or barium enema. Overall mortality was 0.7% (5/697) and four out of five children died needed intestinal resection. Late arrival to hospital (>3days after onset) is significantly associated with requirement of surgery (61/85, 71.8%), which in turn is significantly associated with longer hospital stay (296/452, 65.5%) (p < 0.05). ConclusionsIntussusception occurrence is most frequent between 5-7 months age group which is old enough to be vaccinated under the schedule that has now been introduced in Myanmar. More than half of the cases were treated by surgery and late arrival to hospital enhances requirement of surgery and poor outcome. Findings of this baseline surveillance provide important facts for public health officials in balancing risks and benefits of rotavirus vaccine introduction, defining targeted age and dosage scheduling and facilitate monitoring system in post-vaccination.

Tratamiento de las fístulas uretrorrectales tras prostatectomía radical mediante la interposición de material biológico vía perineal

IntroductionRectal injury is a rare complication after extraperitoneal laparoscopic radical prostatectomy. The development of rectourethral fistulas (URF) from rectal injuries is one of the most feared and of more complex resolution in urology. Material and methodsBetween 2013 and 2020 we have operated on a total of 5 patients with URF after extraperitoneal endoscopic radical prostatectomy through a perineal access using the interposition of biological material. All fistulas had a diameter of less than 6 mm at endoscopy and were less than 6 cm apart from the anal margin. ResultsThe mean age of the patients was 64 years old. All patients had a previous bowel and urinary diversion for at least 3 months. Under general anesthesia and with the patient in a forced lithotomy position, fistulorraphy and interposition of biological material of porcine origin (lyophilized porcine dermis [Permacol®]) were performed through a perineal access. Mean operative time was 174 minutes (140-210). Most patients were discharged on the third postoperative day. The bladder catheter was left in place for a mean of 40 days (30-60). Prior to its removal, cystography and a Gastrografin® barium enema were performed, showing resolution of the fistula in all cases. ConclusionsThe interposition of biological material from porcine dermis through perineal approach is a safe alternative with good results in patients submitted to urethrorectal fistulorraphy after radical prostatectomy.

Frequency, Associated Symptoms and Prognosis of Intussusception in Tertiary Care Hospital of Province Sindh

Background: Intussusception is an important disease of childhood &amp; has been recognized since ancient time. It commonly involves young infants of 3 ½ months to 10 months of age. Diagnosis is mostly clinical on the basis of classical triad or quarter of pain in abdomen, vomiting palpable abdominal mass and currant red jelly stools. It is confirmed by ultrasound, barium enema which also has a therapeutic potential. The parents in our region lacks awareness regarding the intussusception. They usually bring the child to hospitals after trying various homemade or herbal remedies. The delay in diagnosis always results in severity in symptoms and aggressive mode of treatment.&#x0D; Objective: The current study was aimed to identify the Frequency, associated symptoms and post-operative complications of intussusception in tertiary care hospital of Province Sindh&#x0D; Methodology: It was a cross sectional study conducted from July 2017 to June 2020 at department of Pediatric Surgery Ghulam Mohammad Mahar Medical College Teaching Hospital Sukkur. Data regarding symptoms and prognosis was noted on the file of patient and written informed consent was taken from parents. Data was analyzed by using SPSS version 20. Chi square was applied as test of significance at 95%confidance interval and p-value less than 0.05 was considered as significant.&#x0D; Results: Fourty patients of intussusceptions were reported the mean age was 5.88 ± 1.5 months while 8 (20%) patients were 1to10 years with mean age of 3.88± 3.18 years. Thirteen (32.5%) patients presented within 24 hours of onset of symptoms and 27 (67.5%) presented after 24 hours 19 (47.5%) patients had history of diarrhea while 6 (15%) patients had respiratory tract infection. The most common postoperative complication was gut gangrene.&#x0D; Conclusion: In three years of study we found only 40 children who came to our hospital with diarrhea and the triad i.e. abdominal pain, abdominal mass and bleeding per rectum. Ultrasound abdomen was found to be best diagnostic modality with impressive accuracy rate at our setup. Gut gangrene was postoperative complication and recurrence was uncommon.

Pulsion diverticula of the rectum: Radiological diagnosis and clinical implications.

The aim of this study was to investigate the appearance of acquired rectal diverticula on barium enema and computed tomography (CT) and to review the pertinent clinical data about this entity. This series included 3 men and 6 women, who ranged in age from 47 to 82years (average: 64years). Air-contrast barium enema in 6 patients with history of anorectal disease or obstructed defecation demonstrated rectal diverticula. In these cases, multiple radiographs of the rectosigmoid region were obtained in upright position while the patient was relaxing or straining without any attempt to evacuate the barium. In 3 cases, the lateral rectal diverticula were incidental finding on CT studies that were performed for various unrelated abdominal complaints. Pulsion type of diverticulum presenting as a wide-neck outpouching was detected on the lateral rectal wall in 5 and on the posterior wall in 4 patients. They measured 2-3cm in diameter when filled with contrast material or gas, and became even larger when the intraluminal pressure was increased by straining. Pulsion diverticula of the rectum present as a wide-neck outpouching of the lateral or posterior rectal wall in adult patients. This acquired abnormality is usually associated with coexisting anorectal lesions or defecation disorders. The practising radiologists and colorectal surgeons should be aware of this uncommon condition, its appearance on barium enema and other imaging studies, and its clinical implications.

AABH (aspartyl (asparaginyl) β-hydroxylase ) as a serum biomarker for colorectal cancer diagnosis and prognosis.

22 Background: Colorectal cancer (CRC) is the third most common type of cancer diagnosed in the US. The National Comprehensive Cancer Network (NCCN) and the American Cancer Society (ACS) recommend that men and women begin colorectal cancer screening at age 50 or younger if they are at high risk. One of the following screening procedures is recommended: tests for fecal blood annually, a colonoscopy every 5 years, fecal occult blood tests in conjunction with colonoscopy every 5 years, a double-contrast barium enema every 5 years or a colonoscopy every 10 years. Fecal blood tests and colonoscopy are preferred over either test alone. Despite these recommendations, according to The Surveillance, Epidemiology and End Results Data Base (SEER), only 41% of colon cancers are diagnosed when the cancer is still confined to its primary site, 36% are diagnosed when the tumor has spread directly from its primary site or to regional lymph nodes, 19% are diagnosed when the cancer has already metastasized (4% unknown). The corresponding 5-year relative survival rates are 89.8% for localized disease, 67.7% for regional disease, and 10.3% for metastatic disease. Methods: Neither the NCCN nor the ACS recommends that a blood test be done as part of screening. This is due to the fact that, until now, there has not been a blood test with adequate sensitivity or specificity for this purpose. We have investigated the utility of aspartyl (asparaginyl) β-hydroxylase (AABH) as a screening test for colorectal cancer. Results: AABH has been detected by immunohistochemical staining (IHC) on the cell surface of a broad range of cancers including CRC. It has been detected by IHC in &gt; 99% of tumor specimens tested (n &gt; 2300) but has not been found in adjacent normal tissue and in tissue samples from people who do not have cancer. This observation and the observation that AABH is found in the serum of patients with cancer, but not in the serum of people who are cancer-free, led the development of a sandwich ELISA to measure AABH in serum. In the current study we have utilized the serum assay to quantify AABH levels in patients diagnosed with CRC and compared these values with those of people who did not have a diagnosis of cancer. Increased levels of AABH were found in the serum of 99% of patients with CRC (n = 175). In individuals not known to have cancer, AABH was essentially undetectable in serum (n = 213, specificity = 96%). Conclusions: AABH was identified in serum from patients with CRC irrespective of stage. Serum AABH levels for stages I, II, III and IV (local, regional, advanced regional and metastatic) were higher than 0.30 ng/mL (Cut off level). Thus, our data indicate that by measuring AABH in the serum, we should be able to detect colorectal cancer in most individuals at an earlier stage than it is currently detected. Hence, we believe that the broad application of this test could result in a much better 5-year survival for the majority of patients with colorectal cancer.

Prognostic significance of BIRC7/Livin, Bcl-2, p53, Annexin V, PD-L1, DARC, MSH2 and PMS2 in colorectal cancer treated with FOLFOX chemotherapy with or without aspirin.

Evasion of apoptosis is associated with treatment resistance and metastasis in colorectal cancer (CRC). Various cellular processes are associated with evasion of apoptosis. These include overexpression of pro-apoptotic proteins (including p53 and PD-L1), anti-apoptotic proteins (BIRC7/Livin and Bcl-2), chemokine receptors (including DARC), and dysregulation of DNA mismatch repair proteins (including MSH2 and PMS2). The aim of this study was to determine the effect of folinic acid, 5-FU and oxaliplatin (FOLFOX) as a single agent and aspirin plus FOLFOX in various combinations on the aforementioned proteins in human CRC, SW480 cell line and rat models of N-Methyl-N-Nitrosourea (NMU)-induced CRC. In addition, effects of the NMU-induced CRC and chemotherapeutic regimens on haematological and biochemical parameters in the rat models were studied. Immunohistochemistry, immunofluorescence and immunoblot techniques were used to study the expression pattern of the related proteins in the human CRC cells pre- and post-treatment. Double contrast barium enema, post-mortem examination and histological analyses were used to confirm tumour growth and the effect of the treatment in vivo in rat models. Notably, we found in human mucinous CRC, a significant increase in expression of the BIRC7/Livin post-FOLFOX treatment compared with pre-treatment (p = 0.0001). This increase provides new insights into the prognostic role of BIRC7/Livin in evasion of apoptosis and facilitation of treatment resistance, local recurrence and metastasis particularly among mucinous CRCs post-FOLFOX chemotherapy. These poor prognostic features in the CRC may be further compounded by the significant suppression of DARC, PD-L1, PMS2 and overexpression of MSH2 and anti-apoptotic Bcl-2 and p53 proteins observed in our study (p < 0.05). Importantly, we found a significant reduction in expression of BIRC7/Livin and reactivation of DARC and PD-L1 with a surge in Annexin V expression in rat models of CRC cells post-treatment with a sequential dose of aspirin plus FOLFOX compared with other treatments in vivo (p <0.05). The mechanistic rational of these effects underscores the importance of expanded concept of possible aspirin combination therapy with FOLFOX sequentially in future CRC management. Validation of our findings through randomized clinical trials of aspirin plus FOLFOX sequentially in patients with CRC is therefore warranted.

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

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.

Validity of Barium Enema as Hirschsprung’s Disease Diagnostic Tools for Infant in Sanglah Hospital Denpasar

Aim: To determine the validity (sensitivity, specificity, likelihood ratio) of barium enema as Hirschsprung's disease diagnostic tool in infants. Methods: This study was a diagnostic test of barium enema compared with postoperative histopathology examinations as the gold standard. The population were all patients with indigestion symptom be discovered at the pediatric surgical clinic of Sanglah Hospital Denpasar. The sampling method was consecutive sampling, satisfy inclusion criteria (&lt; 12 months old, indicate classic symptoms of Hirschsprung’s disease). The total sample of the study was 52 patients. Sensitivity, specificity, positive and negative predictive value were analysed using cross-tabulation test of barium enema and postoperative histopathology. Results: A total of 52 patients were evaluated during the study period, mean of age was 3.31 months old, and boys:girls (75%:25%). Based on symptoms, 98.08% of patients were delayed release of meconium more than 24-48 hours and abdominal distention. Among all the patients reviewed, sensitivity, specificity, positive and negative predictive value of barium enema for diagnostic of Hirschsprung’s disease was 95.5%, 87.5%, 97.7%, and 77.8%. Conclusion: Barium enema can be used as an early diagnostic tool for infants suspected of Hirschsprung’s disease.

Design microstructure fibers as sensor for protection against x-ray abdominal region exposure

Abstract In this research, two crystalline optical fiber sensors were designed to detect an X-ray exposure dose for the abdominal cross-section imaging. Use solid crystal fibers in the design. A sensor is designed to detect abdominal X-ray radiation where the X-ray doses are high, (computerized tomography (CT), intravenous pyelography (IVP), barium enema (low X-ray GI), study of the upper digestive system with barium). Optical crystal fiber (PCF) was used to detect the intensity of X-rays, the first design was the diameter of the crystal fiber 127.5 μm, while the second design reduced the diameter to 60 μm. The results showed the photon crystal fiber fractionation increases the sensitivity of detecting all variable X-ray doses. We tested the first design by exposing a bundle of the abdominal X-ray to the abdominal segment and proven successful in sensitivity and sensitivity (3.04 nm/mSv). To improve the sensor's work, we developed a second design by reducing the diameter of the crystalline fibers (the waist) to fibers, which proved successful in the few ranges that we could not sense in The first design and we got a sensitivity (1.002 nm/mSv).

Estimating the preferences and willingness-to-pay for colorectal cancer screening: an opportunity to incorporate the perspective of population at risk into policy development in Thailand

Aims Colorectal cancer (CRC) is one of the public health burdens that can be lowered by early detection. This study aims to examine the preferences and willingness-to-pay of a population at risk for CRC screening in Thailand. Understanding the preferences for these individuals at risk would help Thailand, as an example of LMICs, to design effective population-based CRC screening programs. Materials and methods A discrete choice experiment (DCE) was conducted among screening-naïve adults aged 50–75 years, who were at risk of CRC, in the out-patient department of a tertiary care hospital in Thailand. A DCE questionnaire was developed from six CRC screening attributes. Each questionnaire was composed of six choice sets and each contained two alternatives described by the different levels of attributes and an opt-out alternative. Participants were asked to choose one alternative from each choice set. A multinomial logit model was developed to determine the relative preference of each attribute. The willingness-to-pays for all attributes and screening modalities and the estimated preferred choices of the annual fecal immunochemical test (FIT), 10-yearly colonoscopy, 5-yearly double-contrast barium enema (DCBE), 5-yearly computed tomographic colonography (CTC), 5-yearly flexible sigmoidoscopy (FS), and no screening was calculated and compared. Results Four hundred participants were included. All attributes, except pain and less bowel preparation, were statistically associated with the participants’ preference (p < .05). They preferred screenings with a high-risk reduction of CRC-related mortality, no complication, 5-year interval, and lower cost. The estimated preferred choices of FIT, colonoscopy, DCBE, CTC, and FS were 38.2%, 11.4%, 14.6%, 9.2%, and 11.4%, respectively. The willingness-to-pays for each screening modality was US$251, US$189, US$183, US$154, and US$142 (8,107, 6,105, 5,911, 4,974, and 4,587 THB) per episode, respectively. Conclusions The risk reduction of CRC-related mortality, complication, screening interval, and cost influenced the CRC screening preferences of Thai adults. FIT was the most preferred. Policymakers can develop a successful CRC screening campaign using these findings, incorporating the perspective of the population at risk in policy formulation to accomplish their goals.

Laparoscopic-assisted transanal pull-through for hirschsprung's children older than 3 years: A case series.

Context:Hirschsprung's disease (HD) is a congenital anomaly affecting the enteric nervous system commonly the rectosigmoid region. Treatment is surgical where the aganglionic segment is resected, and bowel continuity is restored by a coloanal anastomosis. In 1999, Georgeson et al. proposed a new technique of primary laparoscopic-assisted pull-through for HD as a new gold standard.Aim:The aim of the study was to evaluate the outcome of the laparoscopic-aided transanal pull-through procedure for the management of HD in children older than 3 years of age.Methods:This study was conducted on 15 consecutive patients presented to a university hospital, diagnosed as having HD relying on their clinical features, barium enema study and rectal biopsy. In all cases, laparoscopic-assisted transanal pull-through was attempted. The laparoscopic part included transition zone identification, seromuscular biopsy for fresh frozen histopathology and sigmoid and rectal mobilisation as much as possible down the peritoneal reflection. The transanal part included mobilisation of the rectal lower segment by 2–3 cm, resection till the ganglionic segment, and full-thickness two-layer coloanal anastomosis was done.Results:Early complications occurred in eight cases: enterocolitis in four cases and perianal excoriation occurred in four cases. There were no cases of anastomotic leak. Late complications occurred in seven patients: four cases developed stricture at the site of coloanal anastomosis and three cases experienced enterocolitis at 6 and 9 months postoperatively.Conclusion:Laparoscopic-aided transanal pull-through procedure is a safe, feasible modality for the management of HD in children more than 3 years.

Paediatrician’s Suspicion and Radiologist’s Precision in Diagnosing Hirschprung’s Disease in a Child: Case Report

Hirschprung’s disease (HD) is also called as aganglionic megacolon. The entity falls in the group of congenital motor disorders. The usual presentation is in the form of not passing of meconium, abdominal distension with or without vomiting. We present a 2-years old child who was brought with complaints of constipation and difficulty in passing stool. The child was evaluated radiologically by plain radiography, ultrasonography (USG) and barium enema and was diagnosed as a case of short segment type of Hirschsprung disease. The parents had been counselled and advised for pull-through surgery for the child. It is a dilemma for the paediatrician to confirm the diagnosis of Hirschprung’s disease until a radiologically confirmed diagnosis is made. Many cases are delayed for the treatment because of non-diagnosis or delayed diagnosis. The importance lies in the early diagnosis for further surgical management.

Redo pull-through in total colonic aganglionosis due to residual aganglionosis: a single center's experience.

BackgroundReoperation for total colonic aganglionosis (TCA) may be required for residual aganglionosis after an initial radical operation. We aimed to investigate the symptoms, management, and outcomes of patients who required a redo pull-through (Redo PT).MethodsNine TCA patients underwent Redo PT at our center between 2007 and 2017. Their medical records were reviewed. Parental telephone interviews that included disease-specific clinical outcomes were conducted, and post-operative complications and long-term outcomes (including height-for-age/weight-for-age and bowel-function score) were compared to those of single-pull-through (Single PT) patients (n = 21).ResultsAll the nine Redo PT patients suffered obstruction within 1 month after the initial operation that could not be alleviated by conservative treatment. All abdominal X-ray/contrast barium enemas showed proximal bowel dilatation, indicating residual aganglionosis. The median ages at the initial operation and Redo PT were 200 and 509 days, respectively. Reoperation consisted of an intraoperative frozen biopsy and a modified laparotomic Soave procedure in all patients. Post-operative complications included perianal excoriation (n = 3), intestinal obstruction (n = 2), enterocolitis (n = 2), and rectovestibular fistula (n = 1). Seven Redo PT patients were followed up for a mean time of 7.1 ± 2.3 years; six (85.7%) had good growth and four (57.1%) had good bowel-function recovery. Post-operative complications and long-term outcomes were almost equal between the Redo PT and Single PT groups (all P > 0.05).ConclusionTCA patients with recurrent obstructive symptoms and dilated proximal bowel may have residual aganglionosis after an initial operation. Redo PT is effective and provides good long-term outcomes comparable to those of patients who benefited from Single PT.

RARE-49. CHOROID PLEXUS ADENOMA WITHOUT ASSOCIATED HYDROCEPHALUS PRESENTING AS PRECOCIOUS PUBERTY

Precocious puberty (PP) is a rare presentation of intracranial pathology unrelated to the pituitary. PP in this setting is considered a paraneoplastic phenomenon, achieved through synthesis of sex-hormones by the tumor itself or via alterations in the release of gonadotrophins from the pituitary. The latter has been described with masses adjacent to the pituitary or with those which cause hydrocephalus. We describe a case of a choroid plexus papilloma (CPP) without hydrocephalus presenting as precocious puberty. An 18 month-old female presented with 4-months of weight loss, bilateral galactorrhea and constipation. Her weight decreased from the 15th to below the 1st percentile. CBC, celiac and thyroid studies were normal. Prolactin was at the upper limit of normal (25.8;ref 3.3–26.3). Breast ultrasound demonstrated symmetric breast tissue development. She was referred to pediatric gastroenterology for constipation and failure to thrive. Caloric supplementation, bowel regimen and barium enema were recommended. One week later, she was admitted with dehydration, painful constipation and further weight loss in the setting of an acute febrile illness. MRI revealed a normal pituitary and an intraventricular mass without hydrocephalus. She underwent gross total resection of the mass, later determined to be a choroid plexus papilloma. The patient’s galactorrhea resolved abruptly following resection. Because of her galactorrhea, our patient underwent neuroimaging revealing an incidental mass without associated hydrocephalus. To our knowledge, precocious puberty and hyperprolactinemia have not been described in neoplasms distant from the pituitary. Thus, these lesions should be recognized as a potential etiology of precocious puberty and hyperprolactinemia.

Estenose de cólon transverso com realização de transversectomia: relato de caso

A obstrução intestinal ocorre devido a uma diversidade de anomalias congênitas ou adquiridas, sendo a estenose intestinal uma, embora rara, importante causa de obstrução intestinal em recém-nascidos. Contudo, o diagnóstico pode ser retardado visto que nenhum dos sintomas de maior prevalência são patognomônicos da condição e a etiologia da estenose ainda não é bem entendida. Neste trabalho, relatamos o caso de um recém-nascido do sexo feminino que apresentou, desde a primeira semana de vida, quadros recorrentes de vômitos e distensão abdominal, associados a ausência de evacuação. Inicialmente, após enema opaco, foi levantado como hipótese diagnóstica a Doença de Hirschsprung, mas após a manutenção do quadro mesmo com tratamento conservador, foi realizada laparotomia e o caso revelou-se uma estenose de transverso, sendo adotado a correção cirúrgica através da transversectomia com ileostomia e fístula cutânea protetora. Desse modo, o caso foi apresentado com a finalidade de alertar para a necessidade de se considerar os diversos diagnósticos diferenciais na elaboração do pensamento clínico e, nesse caso, a necessidade de se considerar a estenose de intestino na elaboração de diagnósticos diferenciais em lactentes com quadro de constipação crônica.

Lower abdominal and pelvic radiation and testicular germ cell tumor risk.

BackgroundTesticular germ cell tumor (TGCT) incidence has increased in recent decades along with the use and dose of diagnostic radiation. Here we examine the association between reported exposure to diagnostic radiation and TGCT risk.MethodsWe conducted a case-control study of men with and without TGCT recruited from hospital- and population-based settings. Participants reported on exposures to 1) x-ray or CT below the waist and 2) lower GI series or barium enema, which consists of a series of x-rays of the colon. We also derived a combined measure of exposure. We used logistic regression to determine the risk of developing TGCT according to categories of exposures (0, 1–2, or ≥3 exposures) and age at first exposure, adjusting for age, year of birth, race, county, body mass index at diagnosis, family history of TGCT, and personal history of cryptorchidism.ResultsThere were 315 men with TGCT and 931 men without TGCT in our study. Compared to no exposures, risk of TGCT was significantly elevated among those reporting at least three exposures to x-ray or CT (OR≥3 exposures, 1.78; 95% CI, 1.15–2.76; p = 0.010), lower GI series or barium enema (OR≥3 exposures, 4.58; 95% CI, 2.39–8.76; p<0.001), and the combined exposure variable (OR≥3 exposures, 1.59; 95% CI, 1.05–2.42; p = 0.029). The risk of TGCT was elevated for those exposed to diagnostic radiation at age 0–10 years, compared to those first exposed at age 18 years or later, although this association did not reach statistical significance (OR, 2.00; 95% CI, 0.91–4.42; p = 0.086).ConclusionsExposure to diagnostic radiation below the waist may increase TGCT risk. If these results are validated, efforts to reduce diagnostic radiation doses to the testes should be prioritized.

Barium enema findings in total colonic aganglionosis: a single-center, retrospective study

BackgroundPreoperative diagnosis of total colonic aganglionosis is important for the rational choice of treatment. The present study aimed to evaluate the diagnostic performance of radiographic signs on preoperative barium enema in patients with total colonic aganglionosis.MethodsForty-four patients [41 (3-659) days] with total colonic aganglionosis, including 17 neonatal patients, who received preoperative barium enema at Beijing Children’s Hospital, from January 2007 to December 2019 were included. All radiographs were retrospectively restudied by 2 pediatric radiologists to ascertain radiographic signs including rectosigmoid index, transition zone, irregular contraction, gas-filled small bowel, microcolon, question-mark-shaped colon and ileocecal valve reflux. Kappa test was performed to assess the accuracy and consistency of the radiographic signs.ResultsThe 2 radiologists showed slight agreement for gas-filled small bowel, microcolon and rectosigmoid index, fair agreement for transition zone and irregular contraction, and moderate agreement for question-mark-shaped colon and ileocecal valve reflux (Kappa values, 0.043, 0.075, 0.103, 0.244, 0.397, 0.458 and 0.545, respectively). In neonatal patients, the 2 radiologists showed moderate agreement for ileocecal valve reflux and substantial agreement for question-mark-shaped colon (Kappa values, 0.469 and 0.667, respectively). In non-neonatal patients, the 2 radiologists showed substantial agreement for ileocecal valve reflux (Kappa value, 0.628). In 36 patients with total colonic aganglionosis extending to the ileum, the accuracies of question-mark-shaped colon, ileocecal valve reflux and the combination of both were 47%, 53%, and 75%, respectively, in one radiologist and 53%, 50% and 72%, respectively, in the other radiologist.ConclusionsIleocecal valve reflux is a relatively reliable radiographic sign for diagnosing total colonic aganglionosis and could improve the diagnostic accuracy upon combination with question-mark-shaped colon.