title: Contrast enema findings in patients presenting with poor functional outcome after primary repair for Hirschsprung disease.
abstract: BACKGROUND
  The radiologic evaluation of Hirschsprung disease is well described in the literature. However, there is a paucity of literature describing the appearance of the neo-rectum and colon after repair, specifically describing findings in patients with poor functional outcome, which would suggest the need for reoperation.
  
  
  OBJECTIVE
  We describe findings on contrast enema and correlate them with surgical findings at reoperation in children with poor functional outcome after primary repair for Hirschsprung disease who suffer from bowel dysfunction that can manifest with either soiling or obstructive symptoms such as enterocolitis.
  
  
  METHODS
  Children were identified from our colorectal surgery database. At the time of abstract submission, 35 children had contrast enemas prior to reoperation. Additional children continue to present for evaluation. The majority of children included in the study had their primary repair performed elsewhere. The initial procedures included: Duhamel (n = 11), Soave (n = 20) or Swenson (n = 3). One child had undergone a primary Soave repair and subsequently had a Swenson-type reoperation but continued to have a poor outcome. One child's initial surgical repair could not be determined. Images were reviewed by a staff pediatric radiologist and a pediatric radiology fellow.
  
  
  RESULTS
  Findings encountered on contrast enema in these children include a distal narrowed segment due to stricture or aganglionic/transitional zone segment (8), dilated/hypomotile distal segment (7), thickened presacral space due to compressing Soave cuff (11), dilated Duhamel pouch (8), active enterocolitis (3) and partially obstructing twist of the pull-through segment (1).
  
  
  CONCLUSIONS
  Multiple anatomical and pathological complications exist that can lead to bowel dysfunction in children after repair of Hirschsprung disease. Little recent literature exists regarding the radiographic findings in children. We had the opportunity to review a substantial series of these children, describe the contrast enema findings in these difficult cases and correlate them with operative findings. Radiologic evaluation is key to assessing such patients; it defines the potential anatomical problem with the pull-through and facilitates surgical planning.
authors.affiliation: Memphis Radiological PC, Germantown, TN, USA.
authors.forename: Kevin M
authors.initials: KM
authors.lastname: Garrett
authors.forename: Marc A
authors.initials: MA
authors.lastname: Levitt
authors.forename: Alberto
authors.initials: A
authors.lastname: Peña
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Kraus
mesh_terms: D000293:Adolescent; D001466:Barium Sulfate; D002648:Child; D002675:Child, Preschool; D003287:Contrast Media; D004733:Enema; D005260:Female; D006627:Hirschsprung Disease / Q000000981:diagnostic imaging* / Q000601:surgery*; D006801:Humans; D007223:Infant; D007455:Iodine; D008297:Male; D011859:Radiography; D020127:Recovery of Function; D012086:Reoperation; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D016896:Treatment Outcome
chemical_list: D003287:Contrast Media; D001466:Barium Sulfate; D007455:Iodine