Barium enema findings in total colonic aganglionosis: a single-center, retrospective study

Abstract

Background Preoperative diagnosis of total colonic aganglionosis is important for the rational choice of treatment. The present study aimed to evaluate the diagnostic performance of radiographic signs on preoperative barium enema in patients with total colonic aganglionosis. Methods Forty-four patients [41 (3-659) days] with total colonic aganglionosis, including 17 neonatal patients, who received preoperative barium enema at our center, from January 2007 to December 2019 were included. All radiographs were retrospectively restudied by 2 pediatric radiologists to ascertain radiographic signs including rectosigmoid index, transition zone, irregular contraction, gas-filled small bowel, microcolon, question-mark-shaped colon and ileocecal valve reflux. Kappa test was performed to assess the accuracy and consistency of the radiographic signs. Results The 2 radiologists showed slight agreement for gas-filled small bowel, microcolon and rectosigmoid index, fair agreement for transition zone and irregular contraction, and moderate agreement for question-mark-shaped colon and ileocecal valve reflux (Kappa values, 0.043, 0.075, 0.103, 0.244, 0.397, 0.458 and 0.545, respectively). In neonatal patients, the 2 radiologists showed moderate agreement for ileocecal valve reflux and substantial agreement for question-mark-shaped colon (Kappa values, 0.469 and 0.667, respectively). In non-neonatal patients, the 2 radiologists showed substantial agreement for ileocecal valve reflux (Kappa value, 0.628). In 36 patients with total colonic aganglionosis extending to the ileum, the accuracies of question-mark-shaped colon, ileocecal valve reflux and the combination of both were 47%, 53%, and 75%, respectively, in one radiologist and 53%, 50% and 72%, respectively, in the other. Conclusion Ileocecal valve reflux was a reliable radiographic sign for diagnosing total colonic aganglionosis and could improve the accuracy by combination with question-mark-shaped colon.

Sonographic findings of total colonic aganglionosis in a neonate with Haddad syndrome: A case report

“…Berdon et al reported that the microcolon is seen in less than one‐fourth of patients with total colonic aganglionosis on contrast enema 12 . Although some studies have reported varying frequencies of the microcolon in total colonic aganglionosis, 5,6 a normal caliber colon can also be seen 13 . When the aganglionic segment fails to relax, it may appear as a small‐caliber colon; moreover, it fails to pass meconium, and consequently, the colon may be slightly stretched.…”

“…However, Baad et al reported that contrast enema has moderate specificity and low sensitivity for diagnosing HD in neonates 4 . Furthermore, it is difficult to distinguish total colonic aganglionosis from other low intestinal obstructions using contrast enema 5,6 . Although the use of ultrasound (US) in the diagnosis of HD is limited, a few case studies have described the sonographic findings in fetuses and neonates 7–11 .…”

“…4 Furthermore, it is difficult to distinguish total colonic aganglionosis from other low intestinal obstructions using contrast enema. 5,6 Although the use of ultrasound (US) in the diagnosis of HD is limited, a few case studies have described the sonographic findings in fetuses and neonates. [7][8][9][10][11] Here, we report the unique sonographic findings of total colonic aganglionosis in a term neonate with Haddad syndrome.…”

Tuberkulosis Traktus Urinarius

“…Ultrasonografi USG transrectal (TRUS) dapat mengevaluasi testis, epididimis, prostat dan vesikula seminalis, dimana pada infeksi TB akan terlihat menebal. USG juga bisa juga untuk melihat lokasi kavitas atau abses di ginjal dan melihat keadaan kandung kemih, serta dapat menilai kondisi organ intra abdomen seperti adanya asites, perlekatan antar ogan, maupun pembesaran organ 1,11,12…”

Total Colonic Aganglionosis: Dilema Diagnosis Dan Dampak Jangka Panjang

“…2,11 Namun pada studi yang dilakukan oleh Yan, et al (2020), didapatkan bahwa kombinasi gambaran kolon berbentuk tanda tanya disertai refluks katup ileocecal dapat meningkatkan akurasi diagnosis TCA hingga 75%. 12 Diagnosis TCA juga harus dipikirkan jika terdapat gejala klinis obstruksi bertahan tanpa adanya penyebab lain yang diketahui, dengan gambaran radiologis yang menunjukkan gambaran normal kolon. 2,11…”