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Original Article

Significance of Contrast Enema in One-stage Transanal Endorectal Pull-through Operation for Hirschsprung Disease

Man Sik Shin, M.D., Mi Jung Lee, M.D.1, Myung Joon Kim, M.D.1, Young Ju Hong, M.D., He Kyung Chang, M.D., Seok Joo Han, M.D., Jung-Tak Oh, M.D.
Journal of the Korean Association of Pediatric Surgeons 2012;18(2):75-82.
Published online: December 31, 2012

Department of Pediatric Surgery, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea.

1Department of Radiology, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea.

Correspondence: Jung-Tak Oh, M.D., Department of Pediatric Surgery, Severance Children's Hospital Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Korea. Tel: 02)2228-2124, Fax: 02)313-8289, jtoh@yuhs.ac
• Received: September 26, 2012   • Accepted: December 13, 2012

Copyright © 2012 Korean Association of Pediatric Surgeons

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  • In one-stage transanal endorectal pull-through operation (TERPT) for Hirschsprung disease, preoperative evaluation by contrast enema (CE) is important tool in aspect of planning of surgical procedure as well as diagnosis. This study was to evaluate the significance of CE for identifying the extent of aganglionic bowel. A retrospective analysis was performed in 40 patients who underwent TERPT between 2003 and 2011. The authors reviewed the CE studies and their correlation with pathologic extent of aganglionosis. Total 66 contrast enemas were performed in 40 patients. Twenty patients underwent single CE, but 20 patients required multiple CEs. In single CE group, 17 had clear radiographic transition zone, but 3 had less definite transition zone. In multiple CE group, 17 patients who had equivocal finding in first or second CE had definite radiographic transition zone, but 3 patients of this group had less definite radiographic transition zones. Overall, 34 patients (85%) had clear radiographic transition zone by single or repeated CE. One (2.9%) out of 34 patients with clear radiographic transition zone had discordance between radiographic and pathologic transition zone. In contrast 4 (66.7%) out of 6 patients with equivocal radiographic transition zone had discordance between radiographic and pathologic transition zone. Observation of clear radiographic transition zone is important in preparation of TERPT, and repeated CE is helpful to reduce the discordance between radiographic and pathologic transition zone. Awareness of the possibility of discordance is also important if radiographic transitional zone is not clear.
  • Keywords: Contrast enema; Transanal endorectal pull-through; Hirschsprung's disease
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Fig. 1
A case who required repeated contrast enema (CE). Transition zone was not observed in the first CE (A), but clear transition zone was identified in the second CE (B).
jkaps-18-75-g001.jpg
Table 1
Clinical Characteristics of TERPT

CE; contrast enema

jkaps-18-75-i001.jpg
Table 2
Cases of Discordance between Radiographic and Pathologic Transition Zone

CE; contrast enema

*aganglionic bowel were not found

jkaps-18-75-i002.jpg

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Significance of Contrast Enema in One-stage Transanal Endorectal Pull-through Operation for Hirschsprung Disease
J Korean Assoc Pediatr Surg. 2012;18(2):75-82.   Published online December 31, 2012
DOI: https://doi.org/10.0000/jkaps.2012.18.2.75
Download Citation

Download a citation file in RIS format that can be imported by all major citation management software, including EndNote, ProCite, RefWorks, and Reference Manager.
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Include:
Significance of Contrast Enema in One-stage Transanal Endorectal Pull-through Operation for Hirschsprung Disease
J Korean Assoc Pediatr Surg. 2012;18(2):75-82.   Published online December 31, 2012
DOI: https://doi.org/10.0000/jkaps.2012.18.2.75
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Significance of Contrast Enema in One-stage Transanal Endorectal Pull-through Operation for Hirschsprung Disease
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Fig. 1 A case who required repeated contrast enema (CE). Transition zone was not observed in the first CE (A), but clear transition zone was identified in the second CE (B).

Fig. 1

Significance of Contrast Enema in One-stage Transanal Endorectal Pull-through Operation for Hirschsprung Disease

Clinical Characteristics of TERPT

CE; contrast enema

Cases of Discordance between Radiographic and Pathologic Transition Zone

CE; contrast enema

*aganglionic bowel were not found

Table 1 Clinical Characteristics of TERPT

CE; contrast enema

Table 2 Cases of Discordance between Radiographic and Pathologic Transition Zone

CE; contrast enema

*aganglionic bowel were not found

Table 1

Table 2

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