Sensitivity and Specificity of Barium Enema in the Radiological Diagnosis of Hirschsprung Disease in Children in a Tertiary Pediatric Hospital

Background: Hirschsprung disease (HSCR) is a congenital disorder characterized by the absence of ganglion cells in the distal bowel, leading to functional obstruction.Although rectal biopsy is the gold standard, barium enema remains a widely used diagnostic tool in pediatric radiology, particularly in resource-constrained settings.This study aimed to assess the sensitivity, specificity, and diagnostic performance of barium enema findings in diagnosing HSCR using histopathology as the reference standard.Methods: This cross-sectional observational study was conducted at the Department of Radiology and Imaging, Bangladesh Shishu Hospital & Institute, Dhaka, Bangladesh, from January 2021 to December 2024.A total of 150 children with suspected HSCR underwent barium enema, followed by confirmatory rectal biopsies.The radiological features, including the transitional zone, rectosigmoid index (RSI) <1, and 24-hour retention films, were analyzed.Statistical analyses were performed using SPSS v25.0.Results: Among the 150 participants, 73.3% were male and 44.7% were less than one month old.Clinically, constipation (80.7%), abdominal distension (78.7%), and delayed meconium passage (76.7%) were the most common symptoms.The 24-hour retention film showed the highest sensitivity (92.5%) and specificity (91.4%), followed by the transitional zone (87.3%, 90.1%), and RSI <1 (75.9%, 88.7%).Diagnostic accuracy was highest in children aged 1-12 months and in patients with short-segment disease.Conclusion: Barium enema, particularly the 24-hour delayed film, demonstrates high diagnostic accuracy and remains a valuable noninvasive tool for evaluating HSCR in pediatric patients.