Hirschsprung’s disease Ba enema investigation
Hirschsprung’s disease is a congenital absence of ganglion cells in the myenteric and
submucosal plexus of the bowel [1]. The usual first-line investigation is a water-soluble
contrast enema. However, it is common to verify the diagnosis histologically, usually by a
rectal suction biopsy. The most common finding on a contrast enema is a transition zone.
However, this can often be a false positive [2], leading to unnecessary rectal biopsies
in neonates. We aimed to determine the diagnostic accuracy of contrast enema, the
incidence of a transition zone in patients without the disease and to correlate the number
of radiographic features with the likelihood of positive histology
Examination technique
a. Barium or water soluble contrasts are the routine contrast media used for evaluating childhood Hirschsprung disease. In the neonate or infant water-soluble media diluted to near-isotonic or iso-osmolar concentration are preferred.
b. The rectum should be catheterized with a soft catheter, with the tip just inside the rectum. The caliber of the catheter should be small for the patient’s size in order to avoid effacing a transition zone. No balloon or retention device should be inflated in the rectum during the course of the examination.
c. The examination should be performed under fluoroscopic guidance with positioning to adequately demonstrate the transition zone if present. The child is imaged initially in the lateral position when the rectum and sigmoid colon first fill with contrast. Images are obtained immediately upon early filling and during distension (to avoid under or over distension); this will maximize the detection of Hirshsprung disease.