Distal neonatal intestinal obstruction: the choice of contrast material.

The use of barium sulfate as the contrast agent of choice in the radiographic evaluation of distal neonatal intestinal obstruction is advocated. The advantages of Gastrografin or other water-soluble contrast materials are far outweighed by their disadvantages, which include the hazards of hypertonic dehydration and the danger of missing the diagnosis of Hirschsprung's disease. Five patients are presented, all of whom had the diagnosis of Hirschsprung's disease missed in the neonatal period with one use of Gastrografin enemas. All five were subsequently admitted to the Surgical Neonatal Intensive Care Unit, critically ill with enterocolitis of Hirschsprung's disease.