Does pre-biopsy contrast enema delay the diagnosis of long segment Hirschsprung's disease?
BACKGROUND
The diagnosis of long segment Hirschsprung's disease (LSHD) is frequently delayed. Our purpose was to: 1) summarize contrast enema (CE) findings in patients with LSHD, and 2) evaluate the utility of CE by comparing LSHD patients managed with/without pre-biopsy CE.


METHODS
All LSHD cases (transition zone [TZ] proximal to the splenic flexure) treated between 1984 and 2009 were stratified according to whether a pre-biopsy CE was done (Group 1) or not (Group 2). CE were reviewed by a single pediatric radiologist, and the original reports were categorized as "helpful", "inconclusive" or "misleading". Group comparisons included elapsed days from admission to diagnostic rectal biopsy/first operation and initial hospitalization length of stay (LOS).


RESULTS
29 patients (16 in Group 1; 13 in Group 2) were identified. CE review revealed TZ in 7/16 (44%); and of these, 6 (86%) underestimated the actual aganglionic segment length. 6/16 (38%) original CE reports were "misleading". Overall, Group 1 patients experienced a significant delay in time to biopsy (p=0.047), first operation (p=0.005), and showed a trend towards prolonged LOS.


CONCLUSIONS
Pre-biopsy CE offers little to the diagnosis of LSHD and may contribute to diagnosis/treatment delays. Even if a TZ is recognized in biopsy proven HD, the predicted aganglionic segment length should not guide the operative planning.
Chen
J Z
JZ
BC Children's Hospital, Pediatric General Surgery, Vancouver, Canada.
Jamieson
D H
DH
Skarsgard
E D
ED
D001466:Barium Sulfate; D001706:Biopsy; D003106:Colon / Q000473:pathology*; D003287:Contrast Media; D004733:Enema; D006627:Hirschsprung Disease / Q000000981:diagnostic imaging* / Q000473:pathology*; D006801:Humans; D011859:Radiography; D012007:Rectum / Q000473:pathology*; D012189:Retrospective Studies
D003287:Contrast Media; D001466:Barium Sulfate