On Evaluation Of Diagnosis Of Hirschsprung Disease By Contrast Enema And Anorectal Manometry

Objective:To weigh the advantages and disadvantages of contrast enema and anorectal manometry for diagnosis of Hirschsprung disease. To analysis the diagnostic utility of the two methods in HD suspected children.Methods:Anorectal manometry and contrast enema were carried out in Hirschsprung disease children who were pathologically certificated at last. All the materials including clinical characters, the results of contrast enema and anorectal manometry were gathered in this study. We tested for differences in sensitivity rates of two methods by modified fourfold table chi-squired test. In the analysis p value <0.05 was considered to be statistically significant.Results:1. Of the 22 cases included in this study, 20 were boys. The median age of the total group was 7.0 months ( mean, 2.4 months, range, 17 days-11.7 years ). All the cases were divided into four teams according their ages ( <1 month, 1 month-3months, 3months-1 year, >1 year). The number of cases in each teams was 3, 4, 5, 10 respectively.2. Among all the cases, the incidences of delayed meconium production, constipation, vomiting, abdominal distention and associated other anomalies were 77.27%, 72.73%, 50.00%, 100.00%, 9.09% respectively. None of these children was preterm.3. The sensitivities of contrast enema and anorectal manometry were 77.27% and 90.91%.Χ2 =0.680, p =0.410. Statistically, there were no differences between the two methods.4. The sensitivities of contrast enema in each teams ( <1 month, 1 month-3months, 3months-1 year, >1 year) were 33.33%, 100.00%, 100.00% and 70.00% respectively, while ones of anorectal manometry were 100.00%, 75.00%, 80.00% and 100.00% respectively.5. No severe complications were observed during and after these tests.Conclusions:1. HD or aganglionosis is one of the most common male-predominant congenital anomalies in digestive tract, which is characterized by delayed meconium production, constipation and abdominal distention.2. Contrast enema and anorectal manometry are both common and effective methods for diagnosis of HD, but anorectal manometry is better in the field of sensitivity. Contrast enema can demonstrate the caliber changes of colon in HD, and anorectal manometry is predominant in the diagnosis of newborn HD and short-segment HD.3. The reflex arc of RAIR in Hirschsprung disease-allied disorder is abnormal, which leads to an atypical RAIR wave form illustrated during the test of anorectal manometry what is a clue for the accurate pathological diagnosis.