A case of ultrashort-segment Hirschsprung’s disease discovered after taking polyethylene glycol electrolyte solution for chronic constipation
0
Citation
8
Reference
10
Related Paper
Abstract:
Abstract We report a case of ultrashort-segment Hirschsprung’s disease (HD) involving a 4-year-old girl. She was born at 29 weeks gestation from a twin pregnancy. She weighed 1013 g. After birth, she received glycerin enemas and sodium picosulfate hydrate to facilitate defecation. She passed stool once every 4–5 days. When she was 4 years old, she was medicated with polyethylene glycol electrolyte solution. After she drank the solution twice, the abdomen distended rapidly without passage of stool. An abdominal X-ray showed a stored stool mass and a barium enema study revealed dilatation from the rectum to the sigmoid colon due to the stool mass. She underwent anorectal manometry and a rectal biopsy, and was suspected to have HD. She underwent a Soave endorectal pull-through with an oblique anastomosis. She passed stool 4–10 times a day for 6 months postoperatively, but the frequency of passing stool gradually deceased without medications.Keywords:
Barium enema
Hirschsprung's disease
Bisacodyl
Enema
Ileostomy
• We studied the usefulness of the barium enema to rule out Hirschsprung's disease (congenital megacolon) in the evaluation of infants with constipation. Results from barium enemas in 58 constipated infants and children who underwent rectal suction biopsies to rule out aganglionosis were evaluated in retrospect for the presence of a transition zone, delayed evacuation of barium, and colonic anatomic abnormalities. As expected, the presence of a transition zone was most accurate in predicting Hirschsprung's disease. Eighty percent of infants with aganglionosis had a roentgenographic transition zone, while 20% did not. Twenty-nine percent of infants with a suspected roentgenographic transition zone did not have aganglionosis. Delayed evacuation of barium was a poor predictor of aganglionosis. The presence of delayed evacuation of barium did not improve the accuracy of the transition zone to predict Hirschsprung's disease. Barium enemas did not reveal any additional colonic anatomic defects other than a transition zone to account for constipation in our study group. These results demonstrated that the barium enema is not a specific enough screening procedure to rule out Hirschsprung's disease in the unobstructed infant. Rectal suction biopsy is diagnostic and should be performed as the procedure of choice in those infants suspected of having Hirschsprung's disease. (AJDC1986;140:881-884)
Barium enema
Hirschsprung's disease
Enema
Cite
Citations (72)
Stimulation of the rectum by stretch results, in the normally innervated bowel, in the reflex relaxation of the internal anal sphincter. The absence of this rectosphincteric reflex in Hirschsprung's disease forms the basis of a simple and safe diagnostic test. Our experience over two years using a simplified air-filled pressure probe system is described, based on the examination of 267 infants and children with abnormal bowel function, of whom 114 were suffering from Hirschsprung's disease.A review of the last 100 consecutive patients examined shows an overall diagnostic reliability of 85%. This was of the same order as that of a barium enema in these patients, and indeed of obtaining the correct diagnosis on the first rectal biopsy. It has proved easier to exclude the disease (90.8%) than to confirm its presence (74.3%), and has been found to be more reliable than the barium enema in the diagnosis of ultrashort segment disease. The commoner pitfalls in the interpretation of the trace are described. We consider that this investigation justifies a place in the routine investigation of Hirschsprung's disease alongside the barium enema and rectal biopsy, and is of particular value as a simple screening test in outpatients.
Barium enema
Hirschsprung's disease
Enema
Barium sulfate
Megacolon
Anal sphincter
Cite
Citations (114)
This account of a new and successful technique in preparing patients for a barium enema examination will interest clinicians, for its eventual adoption by radiologists would greatly reduce the discomfort of this invaluable but disagreeable investigation.
Bisacodyl
Barium enema
Enema
Cathartic
Barium
Barium sulfate
Cite
Citations (7)
Objective To discuss the diagnostic value of barium enema and abdominal X-ray plain films for Hirschsprung's disease in neonates.Methods 33 neonates with Hirschsprung's disease proved by colonic surgery or rectal biopsy were collected.The typical andatypical X-ray features on barium enema and abdominal X-ray plain films were retrospectively analysed.Results In 33 cases,barium enema showed a case of short segment type Hirschsprung's disease,16 cases of common type,2 cases of long segment type and 5 cases of whole colon type.Barium retention in the whole colon in 5 cases and in a part of colon in 21 cases were seen after 24 hours follow-up.2 cases showed irregular bizarre saw-toothed change of rectum and sigmoid colon.On abdominal X-ray plain films,20 cases showed low colonic obstruction and intestinal distention and 5 cases showed less air in intestines.Conclusion Barium enema and abdominal plain films can afford the valuable X-ray diagnosis for Hirschsprung's disease in neonates suspected initially by clinician.
Barium enema
Hirschsprung's disease
Enema
Cite
Citations (0)
Introduction Barium enema was the first method used for the diagnosis of Hirschsprung's disease, with the appearance of anorectal manometry and its combination with rectal suction biopsy, barium enema has lost value as a diagnosis method but it has also gain importance to decide the surgical technique that will be used for the correction of the disease. Aim To determine the correlation between the length of the affected segment showed by barium enema valued and the length of the removed piece. Materials and methods We have studied all Hirschsprung disease's cases diagnosed and treated in our center since 1998, 127 patients underwent Soave-Boley's technique and 51 De La Torre's descent technique. Routinely preoperative barium enema was performed in all cases and determine the location of the transition zone and compared with the aganglionic segment's length specified by pathologist. Results At 90% of cases the transition zone could be seen at barium enema, it's most common location was rectosigmoid. After statistically analysis the length measured at radiology tests and the length of the anatomic piece showed a low correlation (kappa index 0.0159), being highest values at rectosigmoid transition and very low values at long affected segments. Conclusions Barium enema in Hirschsprung's disease is valuable to decide the best surgical technique in each singular case but not to determine the exact length of affected segments. In case of a aganglionic long-segment suspicion, biopsies may be necessary to determinate preoperative length of affected segments.
Barium enema
Hirschsprung's disease
Enema
Barium sulfate
Cite
Citations (5)
During last 10 years, 33 children presenting with a severe constipation (19 of them with subobstruction episodes) have been treated with sphincteromyectomy at ages varying from 3 m. to 13 y. The aetiologic study of the constipation includes a barium enema, a manometric study (for the cases treated since 1975) and a histologic study of the muscular strip obtained during the sphincteromyectomy. The barium enema does not show any specific pattern of Hirschsprung's disease, on the other hand, the manometric study brings more constant arguments to distinguish the idiopathic constipation from the short-segment Hirschsprung's disease. The sphincteromyectomy is done by anal approach (28 times) or by posterior approach (6 times). One patient has had 2 sphincteromyectomies. 14 patients had a Hirschsprung's disease and we find among them 9 very good or good results. 5 failures needed a rectal resection by the Swenson's technique. 19 children had an idiopathic constipation. 2 have not been reviewed. Among the 17 others, we find 11 very good results. No postoperative complications have been observed particularly not any incontinence.
Barium enema
Hirschsprung's disease
Enema
Megacolon
Cite
Citations (1)
Purpose: A barium enema is frequently performed to check for healing prior to ileostomy closure, but there have been reports that ileostomy closure without a contrast study is safe in selected patients. The aim of this study was to assess the necessity of a routine barium enema prior to ileostomy closure. Methods: Between January 1994 and June 2005, 51 patients with a temporary loop ileostomy who had a barium enema prior to ileostomy closure at Chonbuk National University Hospital were retrospectively reviewed. These patients were divided into 2 groups, the protective ileostomy group and the ileostomy-after-leakage group. To examine the necessity of a routine barium enema prior to ileostomy closure, we assessed whether the barium enema results changed management and whether there were pelvic sepsis and obstructive symptoms following ileostomy closure. Results: In the protective ileostomy group (n=39), the barium enema was performed after a mean of 59 days (range: 27151 days). There were no abnormal findings at the barium enema, no schedule changes, no pelvic sepsis, and no obstructive symptoms following ileostomy closure. In the ileostomy-after-leakage group (n=12), the barium enema was performed after a mean of 54 days (range: 3082 days). In 2 patients, with barium enemas at 33 days and 36 days, an anastomotic leakage was found, and ileostomy closure was delayed. Conclusions: In patients with a protective ileostomy, a barium enema prior to ileostomy closure is unnecessary, but in patients with an ileostomy after leakage, barium enema should be considered.
Ileostomy
Barium enema
Enema
Barium sulfate
Cite
Citations (2)
Hirschsprung's disease
Barium enema
Enema
Cite
Citations (0)
Barium enema
Hirschsprung's disease
Enema
Barium sulfate
Megacolon
Cite
Citations (46)
Objective To evaluate the value of anorectal manometry, AchE histochemical staining of rectal mucosal biopsy and barium enema in the diagnosis of allied diseases of Hirschsprung's disease. Methods During the period of 1999 2001, 92 patients underwent surgery for Hirschsprung's disease (HD) or allied diseases of Hirschsprung's disease (HAD). Based on the postoperative pathological examinations, the subjects with coexistence of HD and HAD were excluded from this study. Forty cases with HD (36 males and 4 females, a mean age of 21 months) and thirty four cases with HAD (21 males and 13 females, a mean age of 63 months) were selected. The comparisons were made in terms of the findings from their preoperative anorectal manometry, AChE histochemical staining of rectal mucosal biopsy and barium enema between HD and HAD groups. Results There were very significant differences between HD and HAD patients in these three examinations ( P 0.01 ): In HAD group, 85% had recto anal inhibition reflex (RAIR) and a reflex wave with a shape of W or U. 79% of HAD patients were negative in AChE histochemical staining of rectal mucosal biopsy. The barium enema of the most HAD patients showed no obvious narrow and shift segments, but dilatation and barium stagnation over 24 hours had been observed usually in their colon. Conclusions HD and HAD are two kinds of difference diseases. Though they may present a similar constipation, the classic triad of examinations for HD seems to have an important role in their differential diagnosis.
Barium enema
Hirschsprung's disease
Anorectal manometry
Megacolon
Enema
Barium sulfate
Cite
Citations (1)