Application of a plain abdominal radiograph transition zone (PARTZ) in Hirschsprung's disease
A standard contrast enema for Hirschsprung's disease can sometimes be inconclusive in delineating a transition zone especially in neonates and infants. The aim of this study was to determine the utility and diagnostic accuracy of a plain abdominal radiograph transition zone (PARTZ) in predicting the level of aganglionosis.
A prospective observational study of neonates and infants with biopsy proven Hirschsprung's disease was carried out from March 2004 through March 2006. All patients underwent a plain abdominal radiograph and a contrast enema followed by a rectal biopsy. The transition zone on a plain radiograph (PARTZ) and contrast enema (CETZ) were compared with operative and pathology reports. Results were analyzed by chi square test and expressed as their p values and 95% confidence intervals.
PARTZ and CETZ suggestive of Hirschsprung's disease was seen in 24(89%) and 18(67%) patients respectively. The PARTZ and CETZ matched with the pathologic level of transition zone in 22(92%) and 13(72%) patients, p = 0.001, 95% CI (-1.87 to -0.79). In the 9 (33%) patients in whom contrast enema failed to reveal a transition zone, PARTZ was seen in 6/9(66%) patients and correlated with the pathological level of aganglionosis in 4/6(67%) patients, p = 0.001 95% CI (-1.87 to -0.79). The overall accuracy of PARTZ and CETZ was 96% and 84% respectively, p = 0.008, 95% CI (-6.09 to -3.6).
A plain abdominal radiographic transition zone is reliable in predicting the level of transition zone in cases of inconclusive contrast enema. It may be particularly helpful developing countries where laparoscopic techniques are not available to accurately identify the transition zone.
- Klein, MD, Coran, AG, Wesley, JR, Drongowski, RA (1984) Hirschsprung's disease in the newborn. J Pediatr Surg 19: pp. 370-374 CrossRef
- Rosenfield, NS, Ablow, RC, Markowitz, RI, DiPietro, M, Seashore, JH, Touloukian, RJ, Cicchetti, DV (1984) Hirschsprung disease: accuracy of the barium enema examination. Radiology 150: pp. 393-400
- O'Donovan, AN, Habra, G, Somers, S, Malone, DE, Rees, A, Winthrop, AL (1996) Diagnosis of Hirschsprung's disease. AJR Am J Roentgenol 167: pp. 517-520
- De la Torre-Mondragon, L, Ortega-Salgado, JA (1998) Transanal endorectal pull-through for Hirschsprung's disease. J Pediatr Surg 33: pp. 1283-6 CrossRef
- Langer, JC, Durrant, AC, de la Torre, L, Teitelbaum, DH, Minkes, RK, Caty, MG, Wildhaber, BE, Ortega, SJ, Hirose, S, Albanese, CT (2003) One-stage transanal Soave pullthrough for Hirschsprung disease: a multicenter experience with 141 children. Ann Surg 238: pp. 569-583
- Proctor, ML, Traubici, J, Langer, JC, Gibbs, DL, Ein, SH, Daneman, A, Kim, PC (2003) Correlation between radiographic transition zone and level of aganglionosis in Hirschsprung's disease: Implications for surgical approach. J Pediatr Surg 38: pp. 775-778 CrossRef
- Taxman, TL, Yulish, BS, Rothstein, FC (1986) How useful is the barium enema in the diagnosis of infantile Hirschsprung's disease?. Am J Dis Child 140: pp. 881-884
- Jamieson, DH, Dundas, SE, Belushi, SA, Cooper, M, Blair, GK (2004) Does the transition zone reliably delineate aganglionic bowel in Hirschsprung's disease?. Pediatr Radiol 34: pp. 811-815 CrossRef
- Walsh, MC, Kliegman, RM (1986) Necrotizing enterocolitis: treatment based on staging criteria. Pediatr Clin North Am 33: pp. 179-201
- Karnovsky, MJ, Roots, LA (1964) "Direct-coloring" thiocholine method for cholinesterases. J Histochem Cytochem 12: pp. 219-221
- Mozes, YN, Rachmel, A, Schonfeld, T, Schwarz, M, Steinberg, R, Ashkenazi, S (2004) Difficulties in making the diagnosis of Hirschsprung's disease in early infancy. J Paediatr Child Health 40: pp. 716 CrossRef
- Siegel, MJ, Shackelford, GD, McAlister, WH (1981) The rectosigmoid index. Radiology 139: pp. 497-499
- Kohno, M, Ikawa, H, Fukumoto, H, Okamoto, S, Masuyama, H, Konuma, K (2005) Usefulness of endoscopic marking for determining the location of transanal endorectal pull-through in the treatment of Hirschsprung's disease. Pediatr Surg Int 21: pp. 873-877 CrossRef
- Antao, B, Roberts, J (2005) Laparoscopic-assisted transanal endorectal coloanal anastomosis for Hirschsprung's disease. J Laparoendosc Adv Surg Tech 15: pp. 75-9 CrossRef
- Blake NS: Diagnosis of Hirschsprung's disease and allied disorders. Hirschsprung's disease and allied disorders New York: Harwood Academic Publishers 223–290.
- Das, NL, Hingsbergen, EA (2000) Case 22: total colonic aganglionosis – long-segment Hirschsprung disease. Radiology 215: pp. 391-394
- Sauer, CJ, Langer, JC, Wales, PW (2005) The versatility of the umbilical incision in the management of Hirschsprung's disease. J Pediatr Surg 40: pp. 385-389 CrossRef
- The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1471-2431/7/5/prepub
- Application of a plain abdominal radiograph transition zone (PARTZ) in Hirschsprung's disease
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- Online Date
- January 2007
- Online ISSN
- BioMed Central
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- Author Affiliations
- 1. Division of Pediatric Surgery, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
- 2. Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, India
- 3. Department of Radiology, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
- 4. Department of Pathology, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
- 5. Department of Pediatrics, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
- 6. Department of Anesthesia, B.P. Koirala Institute of Health Sciences, Dharan, Nepal