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

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.

scholarly journals DIAGNOSTIC ACCURACY OF BARIUM ENEMA FINDINGS IN HIRSCHSPRUNG'S DISEASE

2016 ◽  
Vol 29 (3) ◽  
pp. 155-158 ◽  
Author(s):  
Mehran PEYVASTEH ◽  
Shahnam ASKARPOUR ◽  
Nasrollah OSTADIAN ◽  
Mohammad-Reza MOGHIMI ◽  
Hazhir JAVAHERIZADEH
Keyword(s):  
Barium Enema ◽  
Predictive Value ◽  
Hirschsprung's Disease ◽  
Hirschsprung’S Disease ◽  
Transitional Zone ◽  
Dentate Line ◽  
Contrast Enema ◽  
Cross Sectional ◽  
Specificity And Sensitivity ◽  
Sensitivity Specificity

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.

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

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

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

2014 ◽  
Vol 31 (1) ◽  
pp. 11-15 ◽  
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

scholarly journals Neonatal Abdominal Surgery, Our Experiences of 179 Cases

2019 ◽  
Vol 13 (2) ◽  
pp. 82-84
Author(s):  
Amal Chandra Paul ◽  
Md Kamrul Hassan ◽  
Md Mizanur Rahman Shibly ◽  
AA Chowdhury
Keyword(s):  
Abdominal Surgery ◽  
Postoperative Mortality ◽  
Oral Feeding ◽  
College Hospital ◽  
Term Survival ◽  
Female Ratio ◽  
X Ray ◽  
Medical College ◽  
Superficial Wound ◽  
Substantial Risk

This is a retrospective study carried out in the Department of Pediatric Surgery, Faridpur Medical College Hospital and in Dr. Zahed Children Hospital at Faridpur, during the period of May 2002 to may 2016. Total 179 neonates were treated by laparotomy for intestinal obstruction after clinical diagnosis and resuscitation. The male to female ratio was 4:5. Most of the patients presented within 02 -25 days of age. In all cases diagnosis was done on history, clinical examination and investigations. The investigations were plain x-ray abdomen in all cases and contrast x-ray upper GIT in 10 cases and enema x-ray in 11 cases and sonogram in 15 cases. Serum electrolytes were not estimated in all patients. There were 34 postoperative mortality. We did loop diversion for 81 cases those who were in potential risk to develop septicemia. Oral feeding started at 3rd postoperative day in diversion cases and 4th postoperative day in resection and end to end anastomosis cases. Superficial wound infection was encountered in 39 cases. Anorectal malformation, IHPS, Exomphaious, Gastroschisis were not included in this study. Long term survival of neonatal abdominal surgery are excellent, however patients have substantial risk to develop intra-abdominal complications. Faridpur Med. Coll. J. Jul 2018;13(2): 82-84

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

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

Modified Duhamel Retrorectal Pull-Through for Hirschsprung’s Disease

2021 ◽  
Vol 15 (10) ◽  
pp. 2886-2889
Author(s):  
Shafiq ur Rehman ◽  
Muhammad Anwar ◽  
Zarlish Fazal
Keyword(s):  
Hirschsprung's Disease ◽  
Hirschsprung’S Disease ◽  
Operation Time ◽  
Clinical Score ◽  
Toilet Training ◽  
Paediatric Surgery ◽  
Short Term ◽  
Female Ratio ◽  
Bowel Habits ◽  
Pull Through

Objectives: To evaluate the post-operative complications and short-term outcomes of modified Duhamel retrorectal pull-through procedure for Hirschsprung’s disease. Design: Prospective descriptive study Place and Duration of Study: Department of Paediatric Surgery Sahiwal Teaching Hospital Sahiwal from 1stJanuary 2018 to 31st December 2020. Methodology: Thirty seven histologically confirmed cases of Hirschsprung’sdisease having previous decompressing colostomy/stoma age between 1 to 12 years of agewere included. Children under one year of age, with sever comorbidities like Down syndrome and cardiac abnormalities, and those who require re-do pull through procedure were excluded. Modified Duhamel retrorectal pull-through procedure was performed in all cases. The demographic information included age, sex, proximal level of aganglinosis, complications of definite procedure, length of hospitalization andmortality. Other information recorded included long term complications like obstructive symptoms, enterocolitis, incontinence and soiling at follow up. Krickenbeck classification was used to evaluate faecal incontinence and constipation. Kelly’s clinical score was used to assess the anal sphincter. Bowel habits were assessed only in children above three years of age. Results: Twenty six (70.27%) were males and 11 (29.72%) females with male to female ratio 2.3:1 and mean age at operation was 2.89±1-9 years. Twenty nine (78.37%) children were ≤3 years of age and 8 (21.62%) were >3 years. Mean weight was 12.91 kgs, operation time was 126.81 time, fasting time was 6.67 days and hospital stay was 11.91 days. Length of aganglionic segment was short segment 27 (72.97%), long segment 9 (24.32%) and total colonic 1 (2.7%). Hirschsprung associated enterocolitis 7 (18.91%) and wound infection 6(16.21%) were most common reported complications. Constipation in 5(13.51) and soiling with retentive constipation was present in 3 (8.10%) patients. Out of total 31 patients who reached toilet training age, 28 (90.32%) developed satisfactory voluntary bowel habits. Conclusion: Modified Duhamel pull-through procedure was found to be safe, applicable and with lower associated complications and satisfactory short term functional outcomes in our settings. Key words: Hirschsprung’s disease, Modified Duhamel pull-through procedure, Complications, Outcomes

Letters to the Editor

PEDIATRICS ◽  
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.

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

2000 ◽  
Vol 30 (10) ◽  
pp. 681-684 ◽  
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

Short-Segment Hirschsprung's Disease

1988 ◽  
Vol 18 (1) ◽  
pp. 16-19 ◽  
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.

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