title: The barium enema in constipation: comparison with rectal manometry and biopsy to exclude Hirschsprung's disease after the neonatal period.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Radiology, The Cleveland Clinic Children's Hospital, OH 44195, USA. reidj@ccf.org
authors.forename: J R
authors.initials: JR
authors.lastname: Reid
authors.forename: C
authors.initials: C
authors.lastname: Buonomo
authors.forename: C
authors.initials: C
authors.lastname: Moreira
authors.forename: H
authors.initials: H
authors.lastname: Kozakevich
authors.forename: S J
authors.initials: SJ
authors.lastname: Nurko
mesh_terms: D000293:Adolescent; D000367:Age Factors; D001466:Barium Sulfate; D002648:Child; D002675:Child, Preschool; D003248:Constipation / Q000175:diagnosis*; D003937:Diagnosis, Differential; D004733:Enema; D005260:Female; D006627:Hirschsprung Disease / Q000175:diagnosis* / Q000000981:diagnostic imaging; D006801:Humans; D007223:Infant; D008297:Male; D008365:Manometry; D011859:Radiography; D012007:Rectum
chemical_list: D001466:Barium Sulfate