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

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.