Barium Enema in the Diagnosis of Hirschsprung's Disease: A Comparison with Rectal Biopsy

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.

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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

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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

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Rectal Biopsy for Hirschsprung's Disease – Are We Performing too Many?

European Journal of Pediatric Surgery ◽

10.1055/s-0029-1241820 ◽

2010 ◽

Vol 20 (02) ◽

pp. 95-97 ◽

Cited By ~ 15

Author(s):

N. Rahman ◽

J. Chouhan ◽

S. Gould ◽

Vt. Joseph ◽

H. Grant ◽

...

Keyword(s):

Hirschsprung's Disease ◽

Hirschsprung’S Disease ◽

Rectal Biopsy

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RECTAL BIOPSY IN HIRSCHSPRUNG'S DISEASE

The Lancet ◽

10.1016/s0140-6736(59)90909-2 ◽

1959 ◽

Vol 273 (7085) ◽

pp. 1236

Keyword(s):

Hirschsprung's Disease ◽

Hirschsprung’S Disease ◽

Rectal Biopsy

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Diagnosing Hirschsprung's disease: Increasing the odds of a positive rectal biopsy result

Journal of Pediatric Surgery ◽

10.1053/jpsu.2003.50070 ◽

2003 ◽

Vol 38 (3) ◽

pp. 412-416 ◽

Cited By ~ 47

Author(s):

Nicola A. Lewis ◽

Marc A. Levitt ◽

Garret S. Zallen ◽

Mona S. Zafar ◽

Karen L. Iacono ◽

...

Keyword(s):

Hirschsprung's Disease ◽

Hirschsprung’S Disease ◽

Rectal Biopsy ◽

Biopsy Result

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Hirschsprung’s Disease: Diagnosis and Management

Journal of Enam Medical College ◽

10.3329/jemc.v10i2.53536 ◽

2021 ◽

Vol 10 (2) ◽

pp. 104-113

Author(s):

Md Benzamin ◽

Md Rukunuzzaman ◽

Md Wahiduzzaman Mazumder ◽

ASM Bazlul Karim

Keyword(s):

Hirschsprung's Disease ◽

Hirschsprung’S Disease ◽

Rectal Biopsy ◽

Disease Diagnosis ◽

Radiological Investigation ◽

Functional Intestinal Obstruction ◽

The Common ◽

High Index Of Suspicion ◽

Hirschprung's Disease ◽

Related Mortality

Hirschsprung’s disease (HD) is a rare genetic congenital defect of intestine causing failure of migration of parasympathetic ganglionic cells in some definite part of intestine, resulting in functional intestinal obstruction. It commonly involves rectosigmoid region of colon but other parts of colon or total colon, even small intestine may be affected. Incidence is 1/5000 live births. It is one of the common pediatric surgical problems and 2nd most organic cause of constipation. Symptoms may be evident from 1st day of life. About 90% infants with Hirschprung’s disease fail to pass meconium in 1st 24 hours of life. About 80% HD cases are diagnosed in early few months of life and present with abdominal distention, constipation, poor feeding, vomiting etc. HD enterocolitis is a devastating condition related to mortality. HD may be associated with some congenital anomalies and syndrome. High index of suspicion is the main key to diagnosis. Radiological investigation supports the diagnosis and rectal biopsy for histopathology is confirmatory. Although it is a surgical problem, physician can play a key role in early diagnosis and thus help to prevent HD enterocolitis-related mortality and restore near-normal life. J Enam Med Col 2020; 10(2): 104-113

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An improved method for the determination of acetylcholinesterase activity in rectal biopsy tissue from patients with hirschsprung's disease

Clinica Chimica Acta ◽

10.1016/0009-8981(77)90247-9 ◽

1977 ◽

Vol 77 (3) ◽

pp. 407-413 ◽

Cited By ~ 38

Author(s):

G. Dale ◽

J.R. Bonham ◽

Katherine W.A. Riley ◽

J. Wagget

Keyword(s):

Hirschsprung's Disease ◽

Hirschsprung’S Disease ◽

Rectal Biopsy ◽

Acetylcholinesterase Activity ◽

Improved Method ◽

Biopsy Tissue

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DIAGNOSTIC ACCURACY OF BARIUM ENEMA FINDINGS IN HIRSCHSPRUNG'S DISEASE

ABCD Arquivos Brasileiros de Cirurgia Digestiva (São Paulo) ◽

10.1590/0102-6720201600030007 ◽

2016 ◽

Vol 29 (3) ◽

pp. 155-158 ◽

Cited By ~ 6

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.

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