Rosenfield N S, Ablow R C, Markowitz R I, DiPietro M, Seashore J H, Touloukian R J, Cicchetti D V
Radiology. 1984 Feb;150(2):393-400. doi: 10.1148/radiology.150.2.6691093.
To determine the relative accuracy of the various radiologic signs of Hirschsprung disease (HD), we retrospectively reviewed both radiographs obtained after a barium enema and the medical records of 62 children who had surgery to prove or exclude the diagnosis of HD. The visualization of a rectosigmoid transition zone was highly predictive of HD, but nonvisualization did not rule out HD. A false positive transition zone at the splenic flexure was seen in four neonates who had small left colon syndrome rather than HD. Retention of barium seen on radiographs obtained 24 hours after a barium enema was not a specific sign, but it was the only sign of HD in seven neonates, including two who had total colonic aganglionosis. Anal manipulation prior to the barium enema examination did not affect the diagnostic value of that procedure. We conclude that the single most reliable radiographic sign of HD is the presence of a rectosigmoid transition zone. Statistically, the use of three radiographic features combined (rectosigmoid transition zone, retention of barium, and stool mixed with barium) correlated better with the presence or absence of HD than did any of these features alone. A comparison of 24 and 48 hour postevacuation radiographs may help to differentiate HD from meconium plug syndrome.
为确定先天性巨结肠（HD）各种放射学征象的相对准确性，我们回顾性分析了62例接受手术以证实或排除HD诊断的儿童的钡剂灌肠后X光片及病历。直肠乙状结肠移行区的显影对HD具有高度预测性，但未显影并不能排除HD。4例患有小左结肠综合征而非HD的新生儿在脾曲处出现了假阳性移行区。钡剂灌肠后24小时X光片上出现的钡剂潴留并非特异性征象，但却是7例新生儿HD的唯一征象，其中包括2例全结肠无神经节症的患儿。钡剂灌肠检查前的肛门操作并不影响该检查的诊断价值。我们得出结论，HD最可靠的单一放射学征象是直肠乙状结肠移行区的存在。从统计学角度来看，联合使用三种放射学特征（直肠乙状结肠移行区、钡剂潴留及钡剂与粪便混合）与HD的有无之间的相关性比单独使用这些特征中的任何一种都更好。比较排空后24小时和48小时的X光片可能有助于将HD与胎粪栓塞综合征区分开来。
