Related Experiment Video
Updated: Mar 13, 2026
Diagnosis of Hirschsprung's Disease by Immunostaining Rectal Suction Biopsies for Calretinin, S100 Protein and Protein Gene Product 9.5
Published on: April 26, 2019
DIAGNOSTIC ACCURACY OF BARIUM ENEMA FINDINGS IN HIRSCHSPRUNG'S DISEASE
Mehran Peyvasteh1, Shahnam Askarpour1, Nasrollah Ostadian1
1Department of Pediatric Surgery, Imam Khomeini Hospital, Iran.
Insights
The transitional zone on barium enema is a highly sensitive indicator for diagnosing Hirschsprung's disease in infants. This study evaluated radiologic findings, confirming its diagnostic value.
Area of Science:
- Pediatric Gastroenterology
- Diagnostic Imaging
- Medical Diagnostics
Background:
- Hirschsprung's disease is the leading cause of intestinal obstruction in children.
- Contrast enema is a key diagnostic tool for Hirschsprung's disease.
Purpose of the Study:
- To assess the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of various radiologic findings in barium enema for diagnosing Hirschsprung's disease.
- To determine the diagnostic accuracy of specific barium enema indicators.
Main Methods:
- A cross-sectional study involving 60 neonates with suspected Hirschsprung's disease.
- Evaluation of radiologic findings including transitional zone, delayed barium evacuation, rectosigmoid index, and mucosal irregularity.
- Comparison of barium enema findings with biopsy results.
Main Results:
- The transitional zone demonstrated high sensitivity (90%) and good PPV (81.8%) for Hirschsprung's disease.
- Rectosigmoid index showed 76.7% sensitivity and 83.3% specificity.
- Irregular contraction and mucosal irregularity were highly specific (100%) but had lower sensitivity.
Conclusions:
- The transitional zone is the most sensitive radiologic finding for Hirschsprung's disease diagnosis via barium enema.
- Irregular contraction and mucosal irregularity are highly specific indicators, aiding in diagnosis confirmation.
Background:
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.
Related Concept Videos
01:23Lower GI Series: Barium Enema
Procedure Details
The examination begins by inserting a lubricated rectal tube into the patient's rectum to administer a radiopaque barium solution. The barium flow is carefully...
01:24Upper GI Series: Barium Swallow
Purpose and Procedure
Patients undergoing this procedure ingest a liquid containing barium sulfate with a chalky...
01:28Peptic Ulcer Disease III: Clinical Manifestations and Diagnostic Studies
Few clinical manifestations differentiate gastric ulcers from duodenal ulcers. Distinctions in the location, timing, and pain relief are crucial for healthcare providers in differentiating between gastric and duodenal ulcers during clinical assessments.
01:25Assessment of the Rectum and Anus
Rectal Inspection
Begin by inspecting the perianal and anal areas for color, texture, rashes,...
01:26Imaging Studies III: Gastrointestinal Motility Studies and Virtual Colonoscopy
Radionuclide Testing
Radionuclide testing is a sophisticated medical technique for assessing gastrointestinal motility. It focuses on gastric emptying and colonic transit time. Radioactive markers track the movement of food through the digestive system, providing insights into gastrointestinal disorders.
In gastric emptying studies, a meal's liquid and...
01:30Irritable Bowel Syndrome II: Clinical Features and Diagnostic Evaluation
Irritable Bowel Syndrome (IBS) is classified into subtypes based on the predominant bowel habits as determined by the Bristol Stool Form Scale (BSFS). The subtypes are: