Infantile Hirschsprung's disease — is a barium enema useful?

This study examined the usefulness of barium enema examination in the diagnosis and evaluation of extent of aganglionosis in the 1st year of life. Twenty-four cases of Hirschsprung's disease in children less than 1 year of age were diagnosed from 1981 to 1989; 17 infants had a barium enema performed. A correct diagnosis was made by barium enema in 13 of the 17 infants, with the level of transition being correctly identified in only 8. Operative assessment of the cone was accurate in 14 of 24 infants, indicating that operative biopsy is always required. Therefore, the barium enema had a 24% false-negative rate in the diagnosis of Hirschsprung's disease and a 53% error rate in determining the level of transition. In the investigation of an infant with a low bowel obstruction, the initial procedure suggested is a rectal washout. If this results in relief of the obstruction, it should be followed by a rectal biopsy. A barium enema adds insignificant information.Offprint requests to: D. CassPaper presented at the Australian Association of Paediatric Surgeons Annual meeting, October 1989