Usefulness of laparoscopy for determining the location of transitional zone in patients with inconclusive barium enema for Hirschsprung’s disease

ABSTRACT 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.

Download Full-text

Barium Enema in Hirschsprung’s Disease : Correlation of Clinical Outcome

Journal of Medical Science & Research ◽

10.47648/jmsr.2018.v2902.05 ◽

2018 ◽

Vol 29 (Number 2) ◽

pp. 24-28

Author(s):

K Laila ◽

T K Chowdhury ◽

S A Talukder ◽

T Banu

Keyword(s):

Sigmoid Colon ◽

Barium Enema ◽

Hirschsprung's Disease ◽

Hirschsprung’S Disease ◽

Transitional Zone ◽

Lateral View ◽

Erect Posture ◽

Female Ratio ◽

X Ray ◽

Medical College

The anticipated level of aganglionosis can influence the surgical planning in Hirschsprung's disease (HD). The aim of this study was to find out the role of barium enema in diagnosis of HD. Barium enema is usually performed in patients referred for investigation for constipation. This prospective study was performed in the department of pediatric surgery Chittagong Medical College & Hospital. During this period a total of 198 patients were clinically diagnosed as HD. All patients were initially evaluated by plain x- ray abdomen in erect posture. Among 198 patients, 43 patients had perforation in plain x- ray and 31 were clinically unstable at presentation. Those 74 patients were excluded from the study. Rest 124 participating patients were divided into three groups: Neonate, Infant and children according to their age. Male to female ratio was 2.44: I. Barium enema X- ray early film, 24 hours delayed film (Antero-posterior and lateral view) were done for every patient. Length of radiological narrow zone (RNZ), radiological Transitional zone (RTZ) and Recto-sigmoid index (RSI) was measured in cm. Photo of X- ray was taken for every patient. RIZ was demonstrated in 74 (60%) patients. RNZ was demonstrated in 94 (75%) studied population. RSI was measured in 65 (52.42%) subjects. Retention of barium more than 24 hours was found in 95 (75%) patients. Redundant sigmoid colon was found in 54 (43.5%) patients. Right-sided sigmoid colon was present in 46(30.6%) patients. Saw-toothed appearance in spastic colon was seen in 38 (30.6%) patients. Mucosal edema and irregularities were present in 25 (20.2%) patients. Rounded transverse colon was seen in 6 children. Barium mixed with stool was found in 32 (25.8%) patients. Mosaic pattern of colon was present in 10 patients. Visualization of RTZ is a reliable sign ofH13. Besides the RIZ BE in HD has various other radiological features.

Download Full-text

Diagnosis of Hirschsprung's Disease: Accuracy of Barium Enema Findings

Journal of the Korean Radiological Society ◽

10.3348/jkrs.1997.36.4.631 ◽

1997 ◽

Vol 36 (4) ◽

pp. 631

Author(s):

Sue Yun Yu ◽

Gye Yeon Lim ◽

Ji Yeong Yun ◽

Seong Tae Hahn ◽

Hak Hee Kim ◽

...

Keyword(s):

Barium Enema ◽

Hirschsprung's Disease ◽

Hirschsprung’S Disease

Download Full-text

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

Pediatric Surgery International ◽

10.1007/s00383-014-3632-5 ◽

2014 ◽

Vol 31 (1) ◽

pp. 11-15 ◽

Cited By ~ 5

Author(s):

C. W. Y. Wong ◽

C. T. Lau ◽

P. H. Y. Chung ◽

W. M. W. Lam ◽

K. K. Y. Wong ◽

...

Keyword(s):

Barium Enema ◽

Hirschsprung's Disease ◽

Hirschsprung’S Disease ◽

Abdominal Radiograph

Download Full-text

Calretinin versus Hematoxylin and Eosin Stain for Diagnosis of Hirschsprung’s Disease; Comparison in Ganglionic, Transitional, and Aganglionic Zones

Journal of the Medical Association of Thailand ◽

10.35755/jmedassocthai.2020.06.11026 ◽

2020 ◽

Vol 103 (6) ◽

pp. 559-565

Keyword(s):

Hirschsprung's Disease ◽

Hirschsprung’S Disease ◽

Ganglion Cells ◽

Transitional Zone ◽

Diagnostic Study ◽

Double Blind ◽

Muscular Layer ◽

Rectal Suction Biopsy ◽

Suction Biopsy ◽

Hematoxylin And Eosin

Objective: To compare the results of calretinin stain with hematoxylin and eosin (H&E) stain for diagnosis of Hirschsprung’s disease. Materials and Methods: A prospective double-blind diagnostic study was done. Hirschsprung’s patients who underwent transanal endorectal pull through (TERPT) surgery between February 2015 and February 2017 were included. The pulled-through specimens were sampled at the ganglionic, transitional, and aganglionic zones. Each specimen was stained with calretinin and H&E. Agreement and kappa analysis were done. Results: Fifty-one Hirschsprung’s patients (153 specimens) were included for analysis. There were 37 males (72.5%) and 14 females (27.5%) with a median age at surgery of four months. Thirty-one specimens showed a negative stain for calretinin (aganglionic bowel) and 33 specimens showed no ganglion cells in the H&E stain. One hundred twenty-two specimens in calretinin stain were consistently positive with ganglionic bowel and 120 specimens in the H&E stain showed ganglion cells. Agreement and Cohen’s kappa coefficient were 97.4% and 0.921 (95% confidence interval 0.845 to 0.997), respectively. Disconcordance was found in four specimens. Three out of four were in the transitional zone. One was in the aganglionic zone, which has no muscular layer attached. (Thirty-six specimens had no muscular layer.) Conclusion: Calretinin stain was found to be comparable with the H&E stain and could be used for diagnosis of Hirschsprung’s disease. In rectal suction biopsy specimen in which the muscular layer was not included, both calretinin and H&E can be used. Keywords: Megacolon, Hematoxylin and eosin (H&E), Calretinin, Rectal suction biopsy (RSB), Full thickness biopsy

Download Full-text

Letters to the Editor

PEDIATRICS ◽

10.1542/peds.37.3.536 ◽

1966 ◽

Vol 37 (3) ◽

pp. 536-536

Author(s):

PETER K. KOTTMEIER

Keyword(s):

Barium Enema ◽

Chronic Constipation ◽

Hirschsprung's Disease ◽

Hirschsprung’S Disease ◽

Rectal Biopsy ◽

Letters To The Editor ◽

Rectal Examination ◽

Rectal Ampulla

Thank you for the Dr. John G. Loeffler's letter and for giving us the opportunity to write a rejoinder to his remarks which were certainly well taken. Dr. Loeffler's rejection of barium enema and rectal biopsy in a child of 2-3 years of age with chronic constipation and stool in the rectal ampulla appears to be justified. We did not emphasize the rectal examination and presence of stool in the ampulla, since in our experience stool can be found in the ampulla even in a patient with Hirschsprung's disease, especially with a low segment.

Download Full-text

The barium enema in constipation: comparison with rectal manometry and biopsy to exclude Hirschsprung's disease after the neonatal period

Pediatric Radiology ◽

10.1007/s002470000298 ◽

2000 ◽

Vol 30 (10) ◽

pp. 681-684 ◽

Cited By ~ 36

Author(s):

J. R. Reid ◽

C. Buonomo ◽

C. Moreira ◽

H. Kozakevich ◽

S. J. Nurko

Keyword(s):

Barium Enema ◽

Hirschsprung's Disease ◽

Hirschsprung’S Disease ◽

Neonatal Period

Download Full-text

Short-Segment Hirschsprung's Disease

Tropical Doctor ◽

10.1177/004947558801800107 ◽

1988 ◽

Vol 18 (1) ◽

pp. 16-19 ◽

Cited By ~ 2

Author(s):

John T Momoh

Keyword(s):

Clinical Diagnosis ◽

Clinical Features ◽

Barium Enema ◽

Muscle Biopsy ◽

Hirschsprung's Disease ◽

Hirschsprung’S Disease ◽

Abdominal Distension ◽

Short Segment ◽

Rectal Muscle

The clinical features and treatment of 15 children with short-segment Hirscbsprung's disease were reviewed. It accounted for 25% of all Hirschsprung's cases seen 1975–84. The symptomatology, which was generally mild, consisted of slowly progressive abdominal distension with one of three defaecating patterns: persistent or intermittent diarrhoea; 2–3 normal daily motions; and constipated stool passed infrequently. Diagnosis was based mainly on the clinical features and barium enema findings. Eight patients had formal sphincterectomy and 3 had rectal muscle biopsy; follow up to 2½ years in some of the patients with sphincterectomy showed satisfactory results. Factors that would expedite clinical diagnosis are discussed.

Download Full-text

Duhamel Procedure untuk Hirschsprung’s Disease Anak di RS Syaiful Anwar Malang

KELUWIH: Jurnal Kesehatan dan Kedokteran ◽

10.24123/kesdok.v2i2.2532 ◽

2021 ◽

Vol 2 (2) ◽

pp. 91-95

Author(s):

Herry Wibowo

Keyword(s):

Barium Enema ◽

Anterior Resection ◽

Low Anterior Resection ◽

Hirschsprung's Disease ◽

Hirschsprung’S Disease ◽

Rectal Biopsy ◽

Full Thickness ◽

Duhamel Procedure ◽

Pull Through ◽

Age Range

Abstract— The diagnosis of Hirschprung's disease is made with barium enema and rectal biopsy in full thickness. The Duhamel procedure was performed in 8 cases in 2008 for cases of Hirschsprung's disease. Age range of patients 7 months to 11 years. The average body weight when operated on is 7-21 kg. Morbidity and mortality after surgery were not launched. Anorectal myectomy with low anterior resection, the Duhamel-Martin procedure, and the Soave pull-through endorectal procedure are the most acceptable methods for surgical management. Hirschsprung's disease was treated in Syaiful Anwar Hospital Malang in 2008 with the following data: 1 person in January (1 year), 1 person in February (6 years), 1 person in March (7 years), 3 people in April ( 7 months, 4 years and 2 years), 2 people in August 2008 (7 months and 11 years). Enlarged abdomen with bloating, repeated constipation and sometimes aborted. Withdrawal procedures that work with endorectal withdrawal procedures, all show long results Keywords: duhamel technique, hirschsprung's disease, constipation, infant Abstrak— Diagnosis penyakit Hirschprung dibuat dengan barium enema dan full-thickness rectal biopsy. Duhamel procedure telah dilakukan pada 8 kasus pada tahun 2008 untuk kasus Hirschsprung's disease. Rentang usia penderita 7 bulan hingga 11 tahun. Berat badan rata – rata saat dioperasi 7 – 21 kg. Morbiditas dan mortalitas setelah operasi tidak dilaporkan. Anorectal myectomy dengan low anterior resection, Duhamel-Martin procedure, dan Soave endorectal pull-through procedure adalah metode yang paling dapat diterima untuk penatalaksanaan bedah. Didapatkan Kasus penyakit Hirschsprung's yang berobat di Rumah Sakit Syaiful Anwar Malang selama tahun 2008 dengan data sebagai berikut yaitu 1 orang di Januari (1 tahun) , 1 orang di Februari (6 tahun), 1 orang Maret (7 bulan), 3 orang April (7 bulan, 4 tahun dan 2 tahun), 2 orang Agustus 2008 (7 bulan dan 11 tahun). Tiap penderita mengalami riwayat abdominal distention dengan gejala perut kembung berulang, konstipasi dan kadang –kadang disertai mual. Delapan penderita yang menjalani operasi dengan prosedur endorectal pullthrough , semuanya menunjukkan hasil jangka panjang yang memuaskan. Kata kunci: tehnik duhamel, penyakit hirschsprung's , konstipasi, infant

Download Full-text

Features of the clinic, diagnosis and tactics of surgical treatment of Hirshprung's disease in infants

Paediatric Surgery Ukraine ◽

10.15574/ps.2021.70.32 ◽

2021 ◽

pp. 32-37

Author(s):

B.B. Ergashev ◽

◽

U.A. Khamroev ◽

Keyword(s):

Surgical Treatment ◽

Early Diagnosis ◽

Chronic Constipation ◽

Hirschsprung's Disease ◽

Hirschsprung’S Disease ◽

Clinical Course ◽

Abdominal Cavity ◽

Transitional Zone ◽

Excretory Urography ◽

General Physical

The aim is to present optimal ways of early diagnosis and tactics of Hirschsprung's disease (HD) surgical correction in newborns and young children based on literature data and our own experience. Materials and methods. Clinical observations on early diagnosis and optimization of the tactics of surgical treatment of HD in 58 infants over the past 9 years have been carried out. All patients underwent a complex of general physical examinations, including the collection of anamnesis and follow-up of patients, clinical examination with rectal examination, laboratory, bacteriological, radiological (survey, polypositional irrigography) and morphological (intraoperatively remote area of the colon agangliosis zone) studies. The features of the clinical course and tactics of surgical treatment of HD in infants, the choice of the surgical method were analyzed, and the risk of complications during the operation was studied. The patients were divided into two groups. The first group included 32 (55.2%) infants with a typical clinical course of HD, radiographically confirmed agangliosis in the rectosigmoid zone, and chronic constipation. The second group included 26 (44.8%) infants with an atypical clinical course of HD with diarrheal syndrome against the background of dysbiosis, enterocolitis, among them there were 2 children with symptoms of Hirschsprung-associated enterocolitis. Research methods: General clinical and biochemical analysis of blood and urine. Scatological examination of feces, sowing on the pathogenic flora of feces and urine. EKG. Ultrasound examination of the abdominal cavity and echocardiography. X-ray examination: an overview roentgenogram of the abdominal and thoracic cavity vertically, irrigoraphy, excretory urography. Results and conclusions. In newborns with sub- and decompensated typical course of chronic constipation in the absence of the effect of conservative therapy, after the diagnosis of HD is established, an early radical operation or colostomy application above the agangliosis zone is recommended. In infants with a favorable typical clinical course and a left-sided form of HD, transanal endorectal reduction of the large intestine (TENTC) can be performed according to indications, starting from one month of age. In this case, the operation of choice is TENTK without colostomy. In subtotal and rectosigmoidal forms of HD with a long aganglionic zone, laparoscopic assistance is recommended, which makes it possible to release the splenic flexure of the colon from ligaments and constrictions, take a full-thickness biopsy of the transitional zone of aganglionicosis, and this makes it possible to conduct express diagnostics, establish resection levels and freely lower the proximal area colon during TENTC. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of all participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors. Key words: Hirschsprung’s disease, clinic, infants, trans anal colon reduction.

Download Full-text