To investigate the significance of the barium enema in the diagnosis of neonatal Hirschsprun's disease(HD), we retrospectively reviewed radiologic findings of the barium enemas, primarily based on transition zone and rectosigmoid index(RSI), in
the
34
neonates with surgically confirmed HD.
We classified the cases into 3 groups, i.e. 1) Compatible HD, showing a cone-shaped transition zone. 2) Suggestive HD, showing questionable transition zone and abnormal RSI(RSI<1). 3) "Unremarkable", showing no transition zone and normal
RSI(RSI>1).
The neonates with HD in this study consisted of 30 ales and 4 females, and majority of them were less than 2 weeks of age at the time of barium enema examination. As for the results from barium enema examination, there were compatible HD in 13
cases(38%), suggestive HD in 9 cases(26%) whose majority proved to have short segment HD, and "unremarkable" in 12 cases(35%). Based on the extent of the aganglionic segment, the sensitivity including the neonates with suggestive HD was 83% in
short
segment HD and 50% in long segment HD. The overall sensitivity based on transition zone and RSI was 65%(23/34).
In summary, these results demonstrate that barium enema in neonatal HD appears to be valuable because the meaningful radiologic findings such as transition zone or abnormal RSI can be expected in approximately two thirds of neonatal HD. In those
neonates who are suspected of having HD but show an equivocal transition zone or no transition zone in barium enema examination, rectal suction biopsy with acetylcholiesterase stain should be performed as the procedure of choice.
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