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Poster - 357
Evaluating the diagnostic value of contrast enemas in Hirschsprung’s disease
Büşra Murat 1, Gonca Gerçel 1, Sabriye Gülçin Bozbeyoğlu 2, Meltem Çağlar 1, Arzu Canmemiş 3, Ersan Uzun 1, Çiğdem Ulukaya Durakbaşa 1
1 Department of Pediatric Surgery, Istanbul Medeniyet University, Faculty of Medicine, Goztepe Prof Dr Suleyman Yalcin City Hospital, Istanbul, Türkiye
2 Department of Radiology, Istanbul Medeniyet University, Faculty of Medicine, Goztepe Prof. Dr. Suleyman Yalcin City Hospital, Istanbul, Türkiye
3 Department of Pediatric Urology, Istanbul Medeniyet University, Faculty of Medicine, Goztepe Prof Dr Suleyman Yalcin City Hospital, İstanbul, Türkiye
Purpose: To assess the diagnostic sensitivity of the rectosigmoid index (RSI) and radiologic transition zone (TZ) on contrast enema in Hirschsprung’s disease (HD).
Method: This retrospective study included 63 HD patients with available radiographs from 106 cases diagnosed between 2006 and 2025. Radiographs were reviewed by a single radiologist. The rectosigmoid index (RSI) is defined as the ratio of the widest rectal diameter to the widest sigmoid diameter. RSI ≤1 was considered diagnostic for HD. Radiologic TZ levels were compared to histopathological TZ.
Results: There were 50 (79.3%) males and 13 (20.7%) females. The median age was 11 months (1 month to 10 years). Thirty-four (54%) patients were <1 year of age, 23 (36.5%) between 1-3 years, and six (9.5%) >3 years. RSI was ≤1.0 in 47 patients (74.6%) and >1.0 in 16 patients (25.4%). According to histopathology, 78% (n=49) of patients had rectosigmoid HD, 13% (n=8) long-segment HD, and 9% (n=6) total colonic HD. Among the 47 patients, the specificity rate for RSI of ≤1.0 was 79.5% (n=39) in rectosigmoid HD, 37.5% (n=3) in long-segment HD and 83.4% (n=5) in total colonic HD. The comparison between radiological and histopathological TZ levels is summarized in Table 1.
Table 1. Sensitivity of contrast enema in predicting the transition zone
|
No TZ Identified on CE (n) |
TZ Identified on CE (n) |
Sensitivity (%) |
Positive Predictive Value (%) |
||
|
Correct |
Incorrect |
||||
|
Rectosigmoid HD (n=49) |
9 |
39 |
1 |
79.6 |
97.5 |
|
Long-segment HD (n=8) |
1 |
7 |
0 |
87.5 |
100 |
|
Total Colonic HD (n=6) |
3 |
0 |
3 |
0 |
0 |
|
Total (n=63) |
13 |
46 |
4 |
73 |
92 |
CE: contrast enema, HD: Hirschsprung’s disease, TZ: Transition zone
Conclusion: An RSI of ≤1 on contrast enema showed only partial concordance with histopathological findings. The sensitivity for detecting the TZ was also suboptimal, suggesting limited diagnostic accuracy. However, when the TZ was clearly visible on contrast radiographies, the predictive value was high. This was most notable in rectosigmoid and long-segment HD. These findings support the potential role of contrast enema in surgical planning when radiologic features are well defined.