Eur J Pediatr Surg 2010; 20(6): 375-378
DOI: 10.1055/s-0030-1262842
Original Article

© Georg Thieme Verlag KG Stuttgart · New York

Does Pre-Biopsy Contrast Enema Delay the Diagnosis of Long Segment Hirschsprung's Disease?

J. Z. Chen1 , D. H. Jamieson2 , E. D. Skarsgard3
  • 1BC Children's Hospital, Pediatric General Surgery, Vancouver, Canada
  • 2BC Children's Hospital, Pediatric Radiology, Vancouver, Canada
  • 3University of British Columbia, Pediatric General Surgery, Vancouver, Canada
Further Information

Publication History

received April 12, 2010

accepted after revision May 01, 2010

Publication Date:
15 October 2010 (online)


Introduction: The diagnosis of long segment Hirschsprung's disease (LSHD) is frequently delayed. Our purpose was to: 1) summarize contrast enema (CE) findings in patients with LSHD, and 2) evaluate the utility of CE by comparing LSHD patients managed with/without pre-biopsy CE.

Methods: All LSHD cases (transition zone [TZ] proximal to the splenic flexure) treated between 1984 and 2009 were stratified according to whether a pre-biopsy CE was done (Group 1) or not (Group 2). CE were reviewed by a single pediatric radiologist, and the original reports were categorized as “helpful”, “inconclusive” or “misleading”. Group comparisons included elapsed days from admission to diagnostic rectal biopsy/first operation and initial hospitalization length of stay (LOS).

Results: 29 patients (16 in Group 1; 13 in Group 2) were identified. CE review revealed TZ in 7/16 (44%); and of these, 6 (86%) underestimated the actual aganglionic segment length. 6/16 (38%) original CE reports were “misleading”. Overall, Group 1 patients experienced a significant delay in time to biopsy (p=0.047), first operation (p=0.005), and showed a trend towards prolonged LOS.

Conclusions: Pre-biopsy CE offers little to the diagnosis of LSHD and may contribute to diagnosis/treatment delays. Even if a TZ is recognized in biopsy proven HD, the predicted aganglionic segment length should not guide the operative planning.


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Dr. Erik D. Skarsgard

University of British Columbia

Pediatric General Surgery

K0-123 ACB

V6H 3V4 Vancouver


Phone: +001 604 875 3744

Fax: +001 604 875 2721