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Barium Enema in the Diagnosis of Hirschsprung’s Disease: A Comparison with Rectal Biopsy

Mohammad Abbas, Arshad Rashid, Asim Rafiq Laharwal, Ajaz Ahmad Wani, Shabir Ahmad Dar, Manzoor Ahamad Chalkoo, Showkat Majeed Kakroo.

Abstract
Aim: The aim of the present study was to compare the diagnostic accuracy of a barium enema in Hirschsprung’s disease with respect to a rectal biopsy.
Materials And Methods: This study was conducted on 60 consecutive patients of clinically suspected cases of Hirschsprung’s disease admitted to a tertiary care hospital in Kashmir over a period of three and a half years. All the patients were subjected to a barium enema and a full-thickness rectal biopsy.
Results: The mean age was 3.5 + 0.5 years. A rectal biopsy revealed absence of ganglion cells in 36 (60%) patients, absence of ganglion cells with nerve hypertrophy in 4 (6.66%) patients and ruled out Hirschsprung’s disease in 20 (33.33%) patients. A barium enema was compatible with Hirschsprung’s disease in 20 (33.33%), suggestive in 14 (23.33%) and unremarkable in 26 (43.33%) patients. A barium enema had a diagnostic accuracy of 76.67% with a positive predictive value of 88.23%, a negative predictive value of 61.53%, specificity of 80% and a sensitivity of 75%, and a rectal biopsy had a diagnostic accuracy of 100% (P value < 0.0001).
Conclusion: Barium enema is a valuable diagnostic tool for the diagnosis of patients with Hirschsprung’s disease. We recommend a barium enema as a routine initial workup in the management of patients of suspected Hirschsprung’s disease.

Key words: Hirschsprung’s disease, barium enema, rectal biopsy, diagnostic accuracy, constipation



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