Purpose or Case Report: 1. To demonstrate the appropriate technique for performing a contrast enema in symptomatic post-surgical Hirschsprung disease (HD).
2. To review the three major surgical procedures used for the primary treatment of HD, their complications, and imaging manifestations.
Methods & Materials: Children who received diagnostic contrast enemas for symptoms of soiling or obstruction after surgery for HD were identified from our radiology and colorectal surgery database. All patients were referred from other institutions with defecation difficulties related to their original HD pull through. Cases with normal and abnormal post-surgical findings were selected for presentation. Key steps and potential pitfalls in the fluoroscopic technique are reviewed.
Results: Optimal fluoroscopic technique involved using non-balloon tipped catheters, using a slightly hyperosmotic contrast agent, obtaining a scout image for assessing the degree of fecal impaction, true lateral filling images with maximal distension of the rectum and distal bowel, and a post evacuation image to evaluate for twists in the pull through segment. Post-surgical complications encountered on contrast enema in these children include a distal narrowed segment due to stricture or aganglionic/transitional zone segment, thickened presacral space due to compressing Soave cuff (figure 1), dilated Duhamel pouch, an obstructing twist of the pull-through segment (figure 2), hypomotile colon, hypermotile colon, and active enterocolitis.
Conclusions: The performance of the contrast enema is crucial to help guide medical and surgical management in symptomatic post-surgical HD patients. Understanding the surgical techniques for the Duhamel, Soave, and Swenson procedure and recognizing common complications is required to accurately perform and interpret these exams.