There are few contraindications. If evaluation of the colonic mucosa is what is clinically desired, then a double contrast barium enema is preferred. If screening for colon cancer, then CT colonography is preferred. One of the most important considerations for a single contrast barium enema is the density of the barium or water-soluble contrast.
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Hirschsprung's disease is the most common cause of pediatric intestinal obstruction. Contrast enema is used for evaluation of the patients with its diagnosis. To evaluate sensitivity, specificity, positive predictive value, and negative predictive value of radiologic findings for diagnosis of Hirschsprung in patients underwent barium enema.
This cross sectional study was carried out in Imam Khomeini Hospital for one year starting from , 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. Biopsy was obtained at three locations apart above dentate line. Mean age of the cases with Hirschsprung's disease and without was The most sensitive finding was transitional zone. The most specific findings were irregular contraction, mucosal irregularity, and followed by cobblestone appearance.
Este estudo transversal foi realizado em Imam Khomeini Hospital por um ano a partir de abril de Hirschsprung's disease HD is a common cause of pediatric intestinal obstruction 9.
It is caused by the failure of the ganglion cells to migrate cephalocaudally through the neural crest causing absence of ganglion cell in all or some parts of colon 1.
In another study from Nigeria, it is the etiology of intestinal obstruction in children with a frequency about Although the initial diagnosis is mainly based on clinical history and examination and followed by pathological examination 3 , radiographic contrast evaluation may be useful in diagnosis Anorectal manometry, rectal suction biopsy, and barium enema are used in our country.
Anorectal manometry is not available in many hospitals. Barium enema BE is available in many centers even without pediatric surgeon. So, the aim of this study was to evaluate sensitivity, specificity, positive predictive value, and negative predictive value of radiologic findings for diagnosis of HD in patients underwent barium enema. This cross sectional study was carried out in Imam Khomeini Hospital. Duration of study was one year starting from April.
Inclusion criteria were: neonates with delayed meconium passage and clinical symptoms of Hirschsprung i. Children with history of anorectal surgery, without follow up were excluded.
Informed consent was signed by all parents before inclusion. All patients underwent barium enema and full thickness rectal biopsy. Barium enema was done under supervision of experienced radiologists who are familiar with pediatric radiology. Following findings were evaluated in BE of each patient: transitional zone TZ , delay in barium evacuation after 24 h, rectosigmoid index RI , mucosal irregularity jejunization , cobblestone appearance, and irregular contraction Figures 1 and 2. Rectosigmoid index is obtained by dividing the widest diameter of the rectum by the widest diameter of the sigmoid loop when the colon is fully distended by the contrast medium 5 , Full thickness biopsy, as a classic approach 4 , was obtained by an experienced pediatric surgeon at three location 2, 5, and 7 cm apart above dentate line.
Proximal and distal ends of biopsy specimens were marked for pathologist. PPV, NPV, specificity and sensitivity was calculated for each finding according to the full thickness biopsy as gold standard. Chi-square was used for analysis. Mean age of the cases with HD and without was Minimum and maximum of age was one and 60 months in both groups. From all cases, abdominal distention was present in 23 Frequency of cobblestone appearance is shown in Table 5. In this study of 60 cases of HD was confirmed using biopsy in 30 cases.
In another study, the majority of the patients presented after the first year of life Of HD cases, In Garcia et al. In another study, The result of the two studies were similar. Mucosal irregularity jejunization was found in 7 Irregularity of mucosa was not found in children without HD in this study and Alehossein et al. The result of two studies were similar.
O'Donovan et al. IC was found in IC was not negative in children with HD in the current and Alehossein and colleagues papers 2. Pratap et al. In Alehossein et al. Garcia et al. Taxman et al. We used barium study in our hospital. It was due to some economic limitation for our patients.
Anorectal manometry was not available due to some limitation. They showed no significant difference among values 5. Previous studies 8 , 18 showed that TZ and RI were the most frequent sign in contrast enema which was similar to our study. Another multicenter research is recommended to evaluate diagnostic accuracy of barium enema in low resource setting.
This paper is issued from residency thesis of Dr. We also acknowledged Department of Pathology for interpretation of biopsy specimens. AG, T. Diagnostic accuracy of radiologic scoring system for evaluation of suspicious hirschsprung disease in children. Iran J Radiol ;e Evaluation and treatment of constipation in infants and children: recommendations of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition.
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BMC Res Notes ; Martucciello G. Hirschsprung's disease, one of the most difficult diagnoses in pediatric surgery: a review of the problems from clinical practice to the bench. Eur J Pediatr Surg ; Diagnosis of Hirschsprung's Disease: an age-related approach in children below or above one year.
Colorectal Dis ; Diagnosis of Hirschsprung's disease. Am J Roentgenol ; Pattern and outcome of childhood intestinal obstruction at a tertiary hospital in Nigeria. Afr Health Sci ; Ileus and intestinal obstruction--comparison between children and adults. Pol Przegl Chir ; Pochaczevsky R, Leonidas JC.
BMC Pediatr ; Skaba R. J Pediatr Surg , Swenson O. Hirschsprung's disease: a review. Pediatrics ; How useful is the barium enema in the diagnosis of infantile Hirschsprung's disease?
Am J Dis Child ; This is an open-access article distributed under the terms of the Creative Commons Attribution License. Services on Demand Journal.
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 , April. Sixty patients were enrolled.
Translation of "baritado" in English
Hirschsprung's disease is the most common cause of pediatric intestinal obstruction. Contrast enema is used for evaluation of the patients with its diagnosis. To evaluate sensitivity, specificity, positive predictive value, and negative predictive value of radiologic findings for diagnosis of Hirschsprung in patients underwent barium enema. This cross sectional study was carried out in Imam Khomeini Hospital for one year starting from , April.
DIAGNOSTIC ACCURACY OF BARIUM ENEMA FINDINGS IN HIRSCHSPRUNG'S DISEASE
Results: 7. Exact: 7. Elapsed time: 33 ms. All rights reserved.