Manzoor Anum, Talat Nabila, Adnan Hafiz Muhammad, Zia Muhammad W, Aziz Muhammad Ahsen, Ahmed Ezza
Pediatric Surgery, The Children's Hospital and University of Child Health Sciences, Lahore, PAK.
Cureus. 2022 Mar 24;14(3):e23458. doi: 10.7759/cureus.23458. eCollection 2022 Mar.
Background Anatomical abnormalities leading to bowel movement failure are the major cause of intestinal obstruction. This study was done to assess the diagnostic efficacy of contrast enema in neonates with lower intestinal obstruction. Methodology This prospective study was conducted in The Children's Hospital and University of Child Health Sciences, Lahore from February 2021 to July 2021. Patients presenting with constipation, abdominal distension, vomiting, and unable to pass meconium, evaluated clinically and by X-rays, were included in the study. Patients with lower intestinal obstruction (i.e., meconium ileus, Hirschsprung's disease, ileal atresia, meconium plug syndrome, and small left colon) were given contrast enema (gastrografin) after hydration. The radiologist was blinded by the clinical diagnosis or reference standard diagnosis, which was labeled prior to image interpretation. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated for major contrast enema diagnosis. Results During this period, a total of 34 patients were included in the study. The mean age of presentation was 72.0 ± 24 hours. There were 21 (61.8%) boys and 13 (38.2%) girls, representing a male to female ratio of 1.7:1. In four cases, our diagnosis on the basis of contrast enema was proven wrong. Sensitivity, specificity, PPV, and NPV of Hirschsprung's disease were found to be 93.3%, 50%, 87.5%, and 66.7%, while these were 84.6%, 66.7%, 91.7%, and 50.0%, respectively, for meconium ileus. Conclusion The diagnostic efficacy of contrast enema was found to be good in neonates with lower intestinal obstruction. The spectrum of intestinal obstruction among neonates shows diversity while contrast enema seems to play a major role in the identification and remodeling of the diagnostic plan in a major proportion of cases.
导致排便功能衰竭的解剖学异常是肠梗阻的主要原因。本研究旨在评估造影灌肠对新生儿低位肠梗阻的诊断效能。
本前瞻性研究于2021年2月至2021年7月在拉合尔儿童医院和儿童健康科学大学进行。纳入出现便秘、腹胀、呕吐且无法排出胎粪的患者，这些患者经过临床评估和X线检查。低位肠梗阻（即胎粪性肠梗阻、先天性巨结肠、回肠闭锁、胎粪堵塞综合征和小左结肠）患者在补液后接受造影灌肠（泛影葡胺）。放射科医生对临床诊断或参考标准诊断不知情，这些诊断在影像解读前已标记。计算造影灌肠主要诊断的敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）。
在此期间，共有34例患者纳入研究。平均就诊年龄为72.0±24小时。有21例（61.8%）男孩和13例（38.2%）女孩，男女比例为1.7:1。在4例病例中，我们基于造影灌肠的诊断被证明是错误的。先天性巨结肠的敏感性、特异性、PPV和NPV分别为93.3%、50%、87.5%和66.7%，而胎粪性肠梗阻的这些指标分别为84.6%、66.7%、91.7%和50.0%。
造影灌肠对新生儿低位肠梗阻的诊断效能良好。新生儿肠梗阻的范围具有多样性，而造影灌肠在大部分病例的诊断计划识别和调整中似乎发挥着主要作用。
