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Pediatric Surgery International

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01-09-2020 | Ileus | Original Article

Diagnostic performance and role of the contrast enema for low intestinal obstruction in neonates

Authors: Michael Baad, Jorge Delgado, Jillian S. Dayneka, Sudha A. Anupindi, Janet R. Reid

Published in: Pediatric Surgery International | Issue 9/2020

Abstract

Purpose

We aim to evaluate the diagnostic performance and relationship between clinical characteristics, imaging findings, and final diagnosis for the neonatal contrast enema (CE).

Methods

Retrospective 10-year review of all neonatal CEs including imaging findings, clinical information, indication, and final diagnosis from discharge summaries, surgical reports, and pathology (reference standard). Two blinded pediatric radiologists reinterpreted 366 CEs for obstruction, microcolon, rectosigmoid index (RSI), serrations, meconium, ileal cut-off, transition zone, diagnosis, and level of confidence. CE diagnostic performance was calculated versus reference standard.

Results

Diagnoses included Hirschsprung disease (HD) (15.8%), small left colon syndrome (14.8%), small intestinal atresia/colonic atresia (SIA/CA) (12.6%), meconium ileus (MI) (4.4%), and normal (48.9%). CE had a moderate specificity (87.7%) and low sensitivity (65.5%) for HD; abnormal RSI and serrations showed high specificities (90.3%, 97.4%) but low sensitivities (46.6%, 17.2%). CE showed high specificity (97.4%) and low sensitivity (56.3%) for MI blinded to cystic fibrosis status. Microcolon was specific (96.6%) but not sensitive (68.8%) for MI. CE showed highest PPV (73.1%) (specificity 95.6%, sensitivity 82.6%) for SIA/CA. Microcolon with an abrupt cut-off was specific (99.1%) but not sensitive (41.3%) for atresias.

Conclusion

Neonatal CE demonstrates high specificities and low to moderate sensitivities across all diagnoses, with lowest performance in HD.

Clinical trial registration

None.

Alehossein M, Roohi A, Pourgholami M et al (2015) Diagnostic accuracy of radiologic scoring system for evaluation of suspicious hirschsprung disease in children. Iran J Radiol 12:e12451. https://doi.org/10.5812/iranjradiol.12451 CrossRefPubMedPubMedCentral

Putnam LR, John SD, Greenfield SA et al (2015) The utility of the contrast enema in neonates with suspected hirschsprung disease. J Pediatr Surg 50:963–966. https://doi.org/10.1016/j.jpedsurg.2015.03.019 CrossRefPubMed

Garcia R, Arcement C, Hormaza L et al (2007) Use of the recto-sigmoid index to diagnose hirschsprung’s disease. Clin Pediatr (Phila) 46:59–63. https://doi.org/10.1177/0009922806289328 CrossRef

Hwang TJ, Servaes S, Mattei P, Anupindi SA (2017) Radiologist performance in the interpretation of contrast enemas performed for hirschsprung’s disease in children >1 year of age. Clin Radiol 72:519.e11–519.e19. https://doi.org/10.1016/j.crad.2017.01.007 CrossRef

Burge D, Drewett M (2004) Meconium plug obstruction. Pediatr Surg Int 20:108–110. https://doi.org/10.1007/s00383-003-1098-y CrossRefPubMed

Ellis DG, William Clatworthy H (1966) The meconium plug syndrome revisited. J Pediatr Surg 1:54–61. https://doi.org/10.1016/0022-3468(66)90008-X CrossRef

Keckler SJ, St Peter SD, Spilde TL et al (2008) Current significance of meconium plug syndrome. J Pediatr Surg 43:896–898. https://doi.org/10.1016/j.jpedsurg.2007.12.035 CrossRefPubMedPubMedCentral

Cuenca AG, Ali AS, Kays DW, Islam S (2012) “Pulling the plug”—management of meconium plug syndrome in neonates. J Surg Res 175:e43–e46. https://doi.org/10.1016/j.jss.2012.01.029 CrossRefPubMed

Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33:159–174. https://doi.org/10.2307/2529310 CrossRefPubMed

10.

Amodio J, Berdon W, Abramson S, Stolar C (1986) Microcolon of prematurity: a form of functional obstruction. AJR Am J Roentgenol 146:239–244. https://doi.org/10.2214/ajr.146.2.239 CrossRefPubMed

11.

Berdon WE, Baker DH, Santulli TV et al (1968) Microcolon in newborn infants with intestinal obstruction. Its correlation with the level and time of onset of obstruction. Radiology 90:878–885. https://doi.org/10.1148/90.5.878 CrossRefPubMed

12.

Carroll AG, Kavanagh RG, Ni Leidhin C et al (2016) Comparative effectiveness of imaging modalities for the diagnosis of intestinal obstruction in neonates and infants: a critically appraised topic. Acad Radiol 23:559–568. https://doi.org/10.1016/j.acra.2015.12.014 CrossRefPubMed

13.

Berrocal T, Lamas M, Gutieérrez J et al (1999) Congenital anomalies of the small intestine, colon, and rectum. Radiographics 19:1219–1236. https://doi.org/10.1148/radiographics.19.5.g99se041219 CrossRefPubMed

14.

Escobar MA, Grosfeld JL, Burdick JJ et al (2005) Surgical considerations in cystic fibrosis: a 32-year evaluation of outcomes. Surgery 138:560–571. https://doi.org/10.1016/j.surg.2005.06.049 (discussion 571) CrossRefPubMed

15.

Carlyle BE, Borowitz DS, Glick PL (2012) A review of pathophysiology and management of fetuses and neonates with meconium ileus for the pediatric surgeon. J Pediatr Surg 47:772–781. https://doi.org/10.1016/j.jpedsurg.2012.02.019 CrossRefPubMed

16.

Farrell PM, Rosenstein BJ, White TB et al (2008) Guidelines for diagnosis of cystic fibrosis in newborns through older adults: cystic fibrosis foundation consensus report. J Pediatr 153:S4–S14. https://doi.org/10.1016/j.jpeds.2008.05.005 CrossRefPubMedPubMedCentral

17.

Fakhoury K, Durie PR, Levison H, Canny GJ (1992) Meconium ileus in the absence of cystic fibrosis. Arch Dis Child 67:1204–1206CrossRefPubMedPubMedCentral

18.

De Lorijn F, Reitsma JB, Voskuijl WP et al (2005) Diagnosis of hirschsprung’s disease: a prospective, comparative accuracy study of common tests. J Pediatr 146:787–792. https://doi.org/10.1016/j.jpeds.2005.01.044 CrossRefPubMed

19.

Hope JW, Borns PF, Berg PK (1965) Roentgenologic manifestations of hirschsprung’s disease in infancy. Am J Roentgenol Radium Ther Nucl Med 95:217–229. https://doi.org/10.2214/ajr.95.1.217 CrossRefPubMed

20.

O’Donovan AN, Habra G, Somers S et al (1996) Diagnosis of Hirschsprung’s disease. AJR Am J Roentgenol 167:517–520. https://doi.org/10.2214/ajr.167.2.8686640 CrossRefPubMed

21.

Lewis NA, Levitt MA, Zallen GS et al (2003) Diagnosing Hirschsprung’s disease: increasing the odds of a positive rectal biopsy result. J Pediatr Surg 38:412–416. https://doi.org/10.1053/jpsu.2003.50070 (discussion 412) CrossRefPubMed

22.

Diamond IR, Casadiego G, Traubici J et al (2007) The contrast enema for hirschsprung disease: predictors of a false-positive result. J Pediatr Surg 42:792–795. https://doi.org/10.1016/j.jpedsurg.2006.12.031 CrossRefPubMed

23.

Taxman TL, Yulish BS, Rothstein FC (1986) How useful is the barium enema in the diagnosis of infantile hirschsprung’s disease? Am J Dis Child 140:881–884PubMed

24.

Reid JR (2012) Practical imaging approach to bowel obstruction in neonates: a review and update. Semin Roentgenol 47:21–31. https://doi.org/10.1053/j.ro.2011.07.003 CrossRefPubMed

25.

Chandler NW, Zwiren GT (1970) Complete reflux of the small bowel in total colon hirschsprung’s disease. Radiology 94:335–339. https://doi.org/10.1148/94.2.335 CrossRefPubMed

26.

De Campo JF, Mayne V, Boldt DW, De Campo M (1984) Radiological findings in total aganglionosis coli. Pediatr Radiol 14:205–209. https://doi.org/10.1007/BF01042242 CrossRefPubMed

27.

Stranzinger E, DiPietro MA, Teitelbaum DH, Strouse PJ (2008) Imaging of total colonic hirschsprung disease. Pediatr Radiol 38:1162–1170. https://doi.org/10.1007/s00247-008-0952-4 CrossRefPubMed

Title: Diagnostic performance and role of the contrast enema for low intestinal obstruction in neonates
Authors: Michael Baad
Jorge Delgado
Jillian S. Dayneka
Sudha A. Anupindi
Janet R. Reid
Publication date: 01-09-2020
Publisher: Springer Berlin Heidelberg
Keywords: Ileus
Cystic Fibrosis
Cystic Fibrosis
Published in: Pediatric Surgery International / Issue 9/2020
Print ISSN: 0179-0358
Electronic ISSN: 1437-9813
DOI: https://doi.org/10.1007/s00383-020-04701-4

At a glance: The STEP trials

Springer Medicine

Diagnostic performance and role of the contrast enema for low intestinal obstruction in neonates

Abstract

Purpose

Methods

Results

Conclusion

Clinical trial registration

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Clinical trial registration

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