Does the transition zone reliably delineate aganglionic bowel in Hirschsprung's disease?
BACKGROUND
Knowledge of the extent of aganglionic bowel is important for preoperative planning of trans-anal surgery in patients with Hirschsprung's disease (HD).


OBJECTIVE
To evaluate the accuracy of the transition zone, as identified by contrast enema study, for identifying the extent of aganglionic bowel.


METHODS
A total of 32 patients with preoperative contrast enema studies and pathologic identification of aganglionic extent were reviewed. Two pediatric radiologists independently reviewed the contrast enema studies. The radiographic transition zone was compared to the pathological extent of aganglionic bowel.


RESULTS
Radiologist agreement of the site of transition zone on contrast enema was 90.6%. The concordance between the radiographic transition zone and pathologic extent of aganglionic bowel was 62.5%. The subgroup of patients with long-segment HD revealed a concordance of only 25%.


CONCLUSIONS
Contrast enema delineation of the transition zone in HD needs to be regarded with caution. This is especially true in long-segment disease, where knowledge of the extent of aganglionic bowel is most crucial to surgical planning.
Jamieson
Douglas H
DH
Department of Radiology, BCCH, 4480 Oak Street, V6H 3V4, Vancouver, BC, Canada. djamieson@cw.bc.ca
Dundas
Simone E
SE
Belushi
Shaika Al
SA
Cooper
Moira
M
Blair
Geoffrey K
GK
D000714:Anastomosis, Surgical / Q000379:methods; D001466:Barium Sulfate; D002648:Child; D003082:Colectomy / Q000379:methods; D003106:Colon / Q000294:innervation / Q000473:pathology / Q000601:surgery; D004733:Enema / Q000379:methods; D005260:Female; D005769:Gastrointestinal Motility / Q000502:physiology; D006627:Hirschsprung Disease / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011300:Preoperative Care; D011859:Radiography; D012189:Retrospective Studies
D001466:Barium Sulfate