O'Donovan A N, Habra G, Somers S, Malone D E, Rees A, Winthrop A L
Department of Radiology, McMaster University, Hamilton, Ontario, Canada.
AJR Am J Roentgenol. 1996 Aug;167(2):517-20. doi: 10.2214/ajr.167.2.8686640.
Our aims were to determine the validity of using low-osmolality water-soluble contrast enemas (WSCE) in neonates and infants with suspected Hirschsprung's disease (HD) and to devise a scoring system that uses a checklist of radiologic signs to determine the probability of HD.
The records of all patients referred by pediatric surgeons from 1988 through 1992 for the radiologic investigation of possible HD were retrospectively reviewed. Thirty-eight patients who were from 2 days to 9 months old were studied; 20 of them were neonates (less than 1 month old). Of all the patients, 24 underwent WSCE and the other 14 underwent barium enema. For all patients, HD had been diagnosed by rectal biopsy or excluded by biopsy, clinical follow-up, or both. Radiographs were read by a gastrointestinal radiologist who used a checklist of diagnostic criteria reported in the literature. The sensitivity had specificity of the findings were compared with those in the literature.
Of the 18 patients with HD, 12 were neonates. All reported radiologic diagnostic criteria were seen; the frequency, sensitivity, and specificity of the findings were reported. Twenty percent (n = 2) of HD patients in the WSCE group (n = 10) had negative findings. Two of the 12 neonates developed colonic perforation, one during the enema and the other within 24 hr of the procedure.
WSCE has a sensitivity and specificity equivalent to those of the barium enema for the detection of HD. For the two patients with perforation, the use of WSCE was of considerable benefit, avoiding the problems associated with barium spillage into the peritoneal cavity. A scoring system for diagnostic enemas is feasible.
我们的目的是确定低渗水溶性造影剂灌肠（WSCE）在疑似先天性巨结肠（HD）的新生儿和婴儿中的有效性，并设计一种使用放射学征象清单来确定HD可能性的评分系统。
回顾性分析1988年至1992年小儿外科医生转诊来进行可能的HD放射学检查的所有患者的记录。研究了38例年龄在2天至9个月的患者；其中20例为新生儿（小于1个月）。所有患者中，24例行WSCE，另外14例行钡剂灌肠。所有患者均经直肠活检确诊HD或经活检、临床随访或两者排除HD。由一位胃肠放射科医生阅读X线片，该医生使用了文献中报道的诊断标准清单。将检查结果的敏感性和特异性与文献中的结果进行比较。
18例HD患者中，12例为新生儿。所有报道的放射学诊断标准均可见；报告了检查结果的频率、敏感性和特异性。WSCE组（n = 10）中20%（n = 2）的HD患者检查结果为阴性。12例新生儿中有2例发生结肠穿孔，1例在灌肠时发生，另1例在操作后24小时内发生。
WSCE在检测HD方面的敏感性和特异性与钡剂灌肠相当。对于2例发生穿孔的患者，使用WSCE有很大益处，避免了钡剂漏入腹腔相关的问题。诊断性灌肠的评分系统是可行的。
