caa a22 4500 475755545 CHVBK 20180406123536.0 cr unu---uuuuu 170329e20000901xx s 000 0 eng 10.1007/s002470000298 doi (NATIONALLICENCE)springer-10.1007/s002470000298 The barium enema in constipation: comparison with rectal manometry and biopsy to exclude Hirschsprung's disease after the neonatal period [Elektronische Daten] [J. R. Reid, C. Buonomo, C. Moreira, H. Kozakevich, S. J. Nurko] Background. The diagnosis of Hirschsprung's disease is usually made in neonates but often considered in older infants and children with constipation: these children may be referred for barium enema. Since it is widely accepted that a normal barium enema does not exclude Hirschsprung's disease, some children, after a normal enema, undergo more invasive procedures such as rectal manometry or biopsy. Our study asked how frequently a diagnosis of Hirschsprung's disease was made by biopsy or manometry in children who had normal barium enema.¶Materials and methods. We reviewed the medical records and barium enemas of 54 patients older than 28 days with constipation or difficulty passing stool who had a barium enema followed by manometry and/or biopsy.¶Results. Forty-eight patients had normal enemas: 24 of those patients had biopsies, 16 had manometry, and 8 both manometry and biopsy. Only 1 had manometry suggestive of Hirschsprung's disease, confirmed by biopsy. Six patients had abnormal enemas. Five had biopsy and manometry compatible with Hirschsprung's disease; one had a normal biopsy and manometry study.¶Conclusion. The barium enema is a good initial screening test for Hirschsprung's disease in severely constipated children since it correlates well with manometry and biopsy. The enema is particularly useful in centers without easy access to pediatric gastroenterology services, and a normal enema in this setting allows the continuation of medical therapy with further evaluation only if there is a lack of response. An abnormal enema, however, requires referral to a facility equipped to perform confirmatory manometry or biopsy. Springer-Verlag Berlin Heidelberg, 2000 Reid J. R. Department of Radiology, Hb6, The Cleveland Clinic Children's Hospital, 9500 Euclid Avenue, Cleveland, OH 44195, USA e-mail: reidj@ccf.org Tel.: + 1-2 16-4 45 29 99 Fax: + 1-2 16-4 45 44 32, US aut Buonomo C. Department of Radiology, Children's Hospital, Boston, Massachusetts, USA, US aut Moreira C. Department of Gastroenterology, Children's Hospital, Boston, Massachusetts, USA, US aut Kozakevich H. Department of Pathology, Children's Hospital, Boston, Massachusetts, USA, US aut Nurko S. J. Department of Gastroenterology, Children's Hospital, Boston, Massachusetts, USA, US aut https://doi.org/10.1007/s002470000298 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s002470000298 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Reid J. R. Department of Radiology, Hb6, The Cleveland Clinic Children's Hospital, 9500 Euclid Avenue, Cleveland, OH 44195, USA e-mail: reidj@ccf.org Tel.: + 1-2 16-4 45 29 99 Fax: + 1-2 16-4 45 44 32, US aut NATIONALLICENCE 700 1- Buonomo C. Department of Radiology, Children's Hospital, Boston, Massachusetts, USA, US aut NATIONALLICENCE 700 1- Moreira C. Department of Gastroenterology, Children's Hospital, Boston, Massachusetts, USA, US aut NATIONALLICENCE 700 1- Kozakevich H. Department of Pathology, Children's Hospital, Boston, Massachusetts, USA, US aut NATIONALLICENCE 700 1- Nurko S. J. Department of Gastroenterology, Children's Hospital, Boston, Massachusetts, USA, US aut Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer