Hirschsprung disease: accuracy of the barium enema examination.

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Abstract
To determine the relative accuracy of the various radiologic signs of Hirschsprung disease (HD), both radiographs obtained after a Ba enema and the medical records of 62 children who had surgery to prove or exclude the diagnosis of HD were reviewed. The visualization of a rectosigmoid transition zone was highly predictive of HD, but nonvisualization did not rule out HD. A false positive transition zone at the splenic flexure was seen in 4 neonates who had small left colon syndrome rather than HD. Retention of Ba seen on radiographs obtained 24 h after a Ba enema was not a specific sign, but it was the only sign of HD in 7 neonates, including 2 who had total colonic aganglionosis. Anal manipulation prior to the Ba enema examination did not affect the diagnostic value of that procedure. The single most reliable radiographic sign of HD apparently is the presence of a rectosigmoid transition zone. Statistically, the use of 3 radiographic features combined rectosigmoid transition zone, retention of Ba and stool mixed with Ba correlated better with the presence or absence of HD than did any of these features alone. A comparison of 24 and 48 h postevacuation radiographs may help to differentiate HD from meconium plug syndrome.