Reid J R, Buonomo C, Moreira C, Kozakevich H, Nurko S J
Department of Radiology, The Cleveland Clinic Children's Hospital, OH 44195, USA.
Pediatr Radiol. 2000 Oct;30(10):681-4. doi: 10.1007/s002470000298.
The diagnosis of Hirschsprung's disease is usually made in neonates but often considered in older infants and children with constipation: these children may be referred for barium enema. Since it is widely accepted that a normal barium enema does not exclude Hirschsprung's disease, some children, after a normal enema, undergo more invasive procedures such as rectal manometry or biopsy. Our study asked how frequently a diagnosis of Hirschsprung's disease was made by biopsy or manometry in children who had normal barium enema.
We reviewed the medical records and barium enemas of 54 patients older than 28 days with constipation or difficulty passing stool who had a barium enema followed by manometry and/or biopsy.
Forty-eight patients had normal enemas: 24 of those patients had biopsies, 16 had manometry, and 8 both manometry and biopsy. Only 1 had manometry suggestive of Hirschsprung's disease, confirmed by biopsy. Six patients had abnormal enemas. Five had biopsy and manometry compatible with Hirschsprung's disease; one had a normal biopsy and manometry study.
The barium enema is a good initial screening test for Hirschsprung's disease in severely constipated children since it correlates well with manometry and biopsy. The enema is particularly useful in centers without easy access to pediatric gastroenterology services, and a normal enema in this setting allows the continuation of medical therapy with further evaluation only if there is a lack of response. An abnormal enema, however, requires referral to a facility equipped to perform confirmatory manometry or biopsy.
先天性巨结肠症通常在新生儿期被诊断出来，但在患有便秘的大龄婴儿和儿童中也经常被考虑：这些儿童可能会被转诊进行钡剂灌肠检查。由于人们普遍认为正常的钡剂灌肠并不能排除先天性巨结肠症，一些儿童在灌肠结果正常后，会接受更具侵入性的检查，如直肠测压或活检。我们的研究旨在探讨在钡剂灌肠正常的儿童中，通过活检或测压诊断先天性巨结肠症的频率有多高。
我们回顾了54例年龄超过28天、有便秘或排便困难症状的患者的病历和钡剂灌肠检查结果，这些患者在接受钡剂灌肠后又进行了测压和/或活检。
48例患者的灌肠结果正常：其中24例患者进行了活检，16例进行了测压，8例同时进行了测压和活检。只有1例测压结果提示先天性巨结肠症，经活检确诊。6例患者的灌肠结果异常。5例患者的活检和测压结果与先天性巨结肠症相符；1例患者的活检和测压检查结果正常。
对于严重便秘儿童，钡剂灌肠是先天性巨结肠症的一种良好的初步筛查方法，因为它与测压和活检结果相关性良好。灌肠在那些不容易获得儿科胃肠病学服务的中心特别有用，在这种情况下，正常的灌肠结果允许继续进行药物治疗，只有在治疗无反应时才进行进一步评估。然而，异常的灌肠结果需要转诊到具备进行确诊性测压或活检设备的机构。
