Abstract
Background: Knowledge of the extent of aganglionic bowel is important for preoperative planning of trans-anal surgery in patients with Hirschsprung’s disease (HD). Objective: To evaluate the accuracy of the transition zone, as identified by contrast enema study, for identifying the extent of aganglionic bowel. Materials and methods: A total of 32 patients with preoperative contrast enema studies and pathologic identification of aganglionic extent were reviewed. Two pediatric radiologists independently reviewed the contrast enema studies. The radiographic transition zone was compared to the pathological extent of aganglionic bowel. Results: Radiologist agreement of the site of transition zone on contrast enema was 90.6%. The concordance between the radiographic transition zone and pathologic extent of aganglionic bowel was 62.5%. The subgroup of patients with long-segment HD revealed a concordance of only 25%. Conclusion: Contrast enema delineation of the transition zone in HD needs to be regarded with caution. This is especially true in long-segment disease, where knowledge of the extent of aganglionic bowel is most crucial to surgical planning.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
O’Donovan AN, Habra G, Somers S, et al (1996) Diagnosis of Hirschsprung’s disease. AJR 167:517–520
Smith GHH, Cass D (1991) Infantile Hirschsprung’s disease—is barium enema useful? Pediatr Surg Int 6:318–321
Taxman TL, Yulish BS, Rothstein FC (1986) How useful is barium enema in the diagnosis of infantile Hirschsprung’s disease? Am J Dis Child 140:881–884
Langer JC, Minkes RK, Mazziotti MV, et al (1999) Transanal one-stage soave procedure for infants with Hirschsprung’s disease. J Pediatr Surg 34:148–152
Ekema G, Falchetti D, Torri F, et al (2003) Further evidence on totally transanal one stage pull-through procedure for Hirschsprung’s disease. J Pediatr Surg 38:1434–1439
Svenson O, Neuhauser EBD, Pickett LK (1948) New concepts of the etiology, diagnosis and treatments of congenital megacolon (Hirschsprung’s disease). Pediatrics 4:201–209
Berdon WE, Baker DH (1965) The roentgenographic diagnosis of Hirschprung’s disease in infancy. AJR 93:432–446
Berlin SC, Sivit CJ, Stringer DA (2000) Functional disorders of large bowel. In: Stringer DA, Babyn PS (eds) Pediatric gastrointestinal imaging and intervention. BC Decker, Hamilton, pp 486–491
Rosenfield NS, Ablow RC, Markowitz RI, et al (1984) Hirschsprungs disease: accuracy of the barium enema examination. Radiology 150:393–400
Andrassy RJ, Isaacs H, Weitzman JJ (1981) Rectal suction biopsy for the diagnosis of Hirschsprung’s disease. Ann Surg 193:419–424
Proctor ML, Traubici J, Langer DL, et al (2003) Correlation between radiographic transition zone and level of aganglionosis in Hirschprung’s disease: implications for surgical approach. J Pediatr Surg 38:775–778
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Jamieson, D.H., Dundas, S.E., Belushi, S.A. et al. Does the transition zone reliably delineate aganglionic bowel in Hirschsprung’s disease?. Pediatr Radiol 34, 811–815 (2004). https://doi.org/10.1007/s00247-004-1292-7
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00247-004-1292-7