Contrast enema of Hirschsprung disease as an alternative diagnostic tool in rural areas

Background and objectives. Hirschsprung disease (HSCR) is a disease caused by the absence of ganglion cells in the myenteric and submucosal plexus of the rectum and colon. Rectal biopsy, the gold standard for diagnosing HSCR requires histological examination, which may not be available in rural areas. Meanwhile, a comprehensive diagnostic approach is essential for ensuring effective HSCR management. We aimed to measure the sensitivity, specificity, and accuracy of contrast enema as an alternative diagnostic tool for HSCR compared to suction rectal biopsy. Materials and methods. We conducted a cross-sectional study which included 35 suspected HSCR patients at Dr. Saiful Anwar General Hospital Malang, Indonesia who met the inclusion criteria. We used the independent t-test and chi-square test to compare study parameters. We measured the sensitivity, specificity, and accuracy of contrast enema of HSCR using a confusion matrix. The odds ratio (OR) was also calculated to indicate the diagnosis of HSCR is correct compared to non-HSCR cases. Results. The sensitivity, specificity, and accuracy of contrast enema of HSCR were 96.55%, 66.67%, and 91.42%, respectively. This study also showed that the OR for contrast enema in diagnosing HSCR is 56 (Confidence interval (CI) 95%: 1.064-113.731). This means that a positive result on contrast enema is 56 times more likely to be associated with HSCR than a negative result. It is important to note that this study has limitations, including a small sample size and being a single-center study. Conclusions. Our findings suggest that contrast enema can be considered a useful tool for diagnosing HSCR in rural areas where histological examination is unavailable.