How useful is the barium enema in the diagnosis of infantile Hirschsprung's disease?
T. L. Taxman, B. S. Yulish and F. C. Rothstein
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.
