Improving the accuracy of contrast enema in diagnosis of Hirschsprung disease

Abstract

Hirschsprung’s disease is one of the most important causes of chronic constipation in children due to its possibly fatal complications if left untreated. Contrast enema is the first investigation done to diagnose Hirschsprung’s disease as it’s the safest, least invasive, most widely available and least expensive as compared to anal manometry and rectal biopsy. Contrast enema had shown variable degree of sensitivity and specificity however, in our study it showed high sensitivity and moderate specificity as compared to other studies. The following CE findings showed a significant association with HD in this study: absence of rectal gas in the plain film, transitional zone, abnormal recto-sigmoid index, enlarged colonic caliber and delayed evacuation. The most reliable sign in our study was abnormal RSI having the highest sensitivity and specificity. In summary, CE is an excellent initial investigation in HD and combining it with detailed history taking and clinical examination can lead to decrease in unnecessary rectal biopsies.