Related Experiment Videos
How useful is the barium enema in the diagnosis of infantile Hirschsprung's disease?
Insights
Barium enemas are not specific enough to rule out Hirschsprung's disease in infants with constipation. Rectal suction biopsy is the preferred diagnostic method for suspected cases of this congenital megacolon.
Area of Science:
- Pediatric Gastroenterology
- Diagnostic Imaging
- Colorectal Surgery
Background:
- Hirschsprung's disease, a form of congenital megacolon, presents with infant constipation.
- Accurate diagnosis is crucial for timely intervention.
Observation:
- A retrospective review of 58 constipated infants and children evaluated Hirschsprung's disease using barium enemas and rectal suction biopsies.
- Key radiographic findings analyzed included transition zones, delayed barium evacuation, and colonic abnormalities.
Findings:
- The presence of a transition zone on barium enema was the most accurate predictor of Hirschsprung's disease, identified in 80% of confirmed cases.
- However, 29% of infants with a suspected transition zone did not have aganglionosis, indicating limited specificity.
- Delayed barium evacuation was an unreliable indicator, and no other significant colonic abnormalities were detected by barium enema.
Implications:
- Barium enema is insufficient as a standalone screening tool to exclude Hirschsprung's disease in unobstructed infants.
- Rectal suction biopsy remains the gold standard diagnostic procedure for infants suspected of having Hirschsprung's disease.
Abstract:
We studied the usefulness of the barium enema to rule out Hirschsprung's disease (congenital megacolon) in the evaluation of infants with constipation. Results from barium enemas in 58 constipated infants and children who underwent rectal suction biopsies to rule out aganglionosis were evaluated in retrospect for the presence of a transition zone, delayed evacuation of barium, and colonic anatomic abnormalities. As expected, the presence of a transition zone was most accurate in predicting Hirschsprung's disease. Eighty percent of infants with aganglionosis had a roentgenographic transition zone, while 20% did not. Twenty-nine percent of infants with a suspected roentgenographic transition zone did not have aganglionosis. Delayed evacuation of barium was a poor predictor of aganglionosis. The presence of delayed evacuation of barium did not improve the accuracy of the transition zone to predict Hirschsprung's disease. Barium enemas did not reveal any additional colonic anatomic defects other than a transition zone to account for constipation in our study group. These results demonstrated that the barium enema is not a specific enough screening procedure to rule out Hirschsprung's disease in the unobstructed infant. Rectal suction biopsy is diagnostic and should be performed as the procedure of choice in those infants suspected of having Hirschsprung's disease.