Application of a plain abdominal radiograph transition zone (PARTZ) in Hirschsprung's disease

被引：13
作者：
Pratap A. [1 ]
Gupta D.K. [2 ]
Tiwari A. [3 ]
Sinha A.K. [4 ]
Bhatta N. [5 ]
Singh S.N. [6 ]
Agrawal C.S. [1 ]
Kumar A. [1 ]
Adhikary S. [1 ]
机构：
[1] Division of Pediatric Surgery, B.P. Koirala Institute of Health Sciences, Dharan
[2] Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi
[3] Department of Radiology, B.P. Koirala Institute of Health Sciences, Dharan
[4] Department of Pathology, B.P. Koirala Institute of Health Sciences, Dharan
[5] Department of Pediatrics, B.P. Koirala Institute of Health Sciences, Dharan
[6] Department of Anesthesia, B.P. Koirala Institute of Health Sciences, Dharan
来源：
BMC Pediatrics | / 7卷 / 1期
关键词：
Transition Zone; Contrast Enema; Pathological Level; Plain Abdominal Radiograph; Bell Staging;
D O I：
10.1186/1471-2431-7-5
中图分类号：
学科分类号：
摘要：
Background: A standard contrast enema for Hirschsprung's disease can sometimes be inconclusive in delineating a transition zone especially in neonates and infants. The aim of this study was to determine the utility and diagnostic accuracy of a plain abdominal radiograph transition zone (PARTZ) in predicting the level of aganglionosis. Methods: A prospective observational study of neonates and infants with biopsy proven Hirschsprung's disease was carried out from March 2004 through March 2006. All patients underwent a plain abdominal radiograph and a contrast enema followed by a rectal biopsy. The transition zone on a plain radiograph (PARTZ) and contrast enema (CETZ) were compared with operative and pathology reports. Results were analyzed by chi square test and expressed as their p values and 95% confidence intervals. Results: PARTZ and CETZ suggestive of Hirschsprung's disease was seen in 24(89%) and 18(67%) patients respectively. The PARTZ and CETZ matched with the pathologic level of transition zone in 22(92%) and 13(72%) patients, p = 0.001, 95% CI (-1.87 to -0.79). In the 9 (33%) patients in whom contrast enema failed to reveal a transition zone, PARTZ was seen in 6/9(66%) patients and correlated with the pathological level of aganglionosis in 4/6(67%) patients, p = 0.001 95% CI (-1.87 to -0.79). The overall accuracy of PARTZ and CETZ was 96% and 84% respectively, p = 0.008, 95% CI (-6.09 to -3.6). Conclusion: A plain abdominal radiographic transition zone is reliable in predicting the level of transition zone in cases of inconclusive contrast enema. It may be particularly helpful developing countries where laparoscopic techniques are not available to accurately identify the transition zone. © 2007 Pratap et al; licensee BioMed Central Ltd.
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共 17 条
[1]  
Klein M.D., Coran A.G., Wesley J.R., Drongowski R.A., Hirschsprung's disease in the newborn, J Pediatr Surg, 19, pp. 370-374, (1984)
[2]  
Rosenfield N.S., Ablow R.C., Markowitz R.I., DiPietro M., Seashore J.H., Touloukian R.J., Cicchetti D.V., Hirschsprung disease: Accuracy of the barium enema examination, Radiology, 150, pp. 393-400, (1984)
[3]  
O'Donovan A.N., Habra G., Somers S., Malone D.E., Rees A., Winthrop A.L., Diagnosis of Hirschsprung's disease, AJR Am J Roentgenol, 167, pp. 517-520, (1996)
[4]  
De la Torre-Mondragon L., Ortega-Salgado J.A., Transanal endorectal pull-through for Hirschsprung's disease, J Pediatr Surg, 33, pp. 1283-1286, (1998)
[5]  
Langer J.C., Durrant A.C., de la Torre L., Teitelbaum D.H., Minkes R.K., Caty M.G., Wildhaber B.E., Ortega S.J., Hirose S., Albanese C.T., One-stage transanal Soave pullthrough for Hirschsprung disease: A multicenter experience with 141 children, Ann Surg, 238, pp. 569-583, (2003)
[6]  
Proctor M.L., Traubici J., Langer J.C., Gibbs D.L., Ein S.H., Daneman A., Kim P.C., Correlation between radiographic transition zone and level of aganglionosis in Hirschsprung's disease: Implications for surgical approach, J Pediatr Surg, 38, pp. 775-778, (2003)
[7]  
Taxman T.L., Yulish B.S., Rothstein F.C., How useful is the barium enema in the diagnosis of infantile Hirschsprung's disease?, Am J Dis Child, 140, pp. 881-884, (1986)
[8]  
Jamieson D.H., Dundas S.E., Belushi S.A., Cooper M., Blair G.K., Does the transition zone reliably delineate aganglionic bowel in Hirschsprung's disease?, Pediatr Radiol, 34, pp. 811-815, (2004)
[9]  
Walsh M.C., Kliegman R.M., Necrotizing enterocolitis: Treatment based on staging criteria, Pediatr Clin North Am, 33, pp. 179-201, (1986)
[10]  
Karnovsky M.J., Roots L.A., Direct-coloring" thiocholine method for cholinesterases, J Histochem Cytochem, 12, pp. 219-221, (1964)
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