Barium Enema – Pathology correlation in Hirschsprung’s disease at TASH & Menelik II Hospital, Addis Ababa, Ethiopia
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Date
2021-10
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Addis Abeba University
Abstract
Background: Hirschsprung’s disease is a common cause of pediatric intestinal
obstruction. It’s a developmental disorder characterized by the absence of ganglion
cells in the myenteric and submucosal plexuses of the distal intestine resulting in
functional obstruction. Barium enema is a simple and primary study for the
evaluation of clinically suspected Hirschsprung’s disease.
Aim:To review the diagnostic performance of barium enema examinations for the
investigation of Hirschsprung’s disease.
Methods: Institution based prospective cross-sectional study at Tikur Anbessa
Specialized - & Menelik II Hospitals was done with clinically HD suspected
patients who have a barium enema & biopsy during the study period, September
2020 to August 2021. Convenience sampling technique was used.
Results: A total of 28 cases were evaluated during the study period all having a
barium enema & biopsy result, of whom 18 were males & 10 were females. The
minimum & maximum ages at presentation were 10 days & 10 years respectively
with the median age being 11 months. Constipation was the most commonly
present clinical symptom followed by abdominal distension & delayed meconium
passage which was found in 50% of the participants.
The overall sensitivity, specificity & accuracy of barium enema was 95%, 71.4 %,
& 88.8 % respectively. Sensitivity, specificity, PPV, and NPV were 90%, 71.4 %,
90% and 71.4 % respectively for recto-sigmoid index in barium enema. Sensitivity,
specificity, PPV, and NPV were 85 %, 85.7%, 94.4% and 66.7 % respectively for
transitional zone. Sensitivity, specificity, PPV, and NPV were 75%, 100%, 100%
and 58.3 % respectively for irregular contraction detected in barium enema.
Sensitivity, specificity, PPV, and NPV were 35%, 100%, 100% and 35 %
respectively for mucosal irregularity detected in barium enema.
Conclusion: The accuracy of barium enema for the diagnosis of HSD was 88.8 %
& hence barium enema can be used as a reliable primary diagnostic modality for
HSD. Irregular contraction & mucosal irregularity were the most specific findings
whereas inverted recto sigmoid index & transition zone had a comparably higher
sensitivity.
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Keywords
Hirschsprung’s disease,Radiology