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Use of the Recto-Sigmoid Index to Diagnose Hirschsprung’s Disease

Department of Pediatrics, Division of Gastroenterology, Baton Rouge, Louisiana

C. Arcement, MD

Department of Radiology, Division of Pediatric Radiology, Baton Rouge, Louisiana

L. Hormaza, MD

Department of Pathology, Division of Pediatric Pathology, Baton Rouge, Louisiana

M. L. Haymon, MD

Department of Radiology, Division of Pediatric Radiology, Baton Rouge, Louisiana

K. Ward, MD

Department of Radiology, Division of Pediatric Radiology, Baton Rouge, Louisiana

C. Velasco, PhD

School of Public Health, Baton Rouge, Louisiana

H. Correa, MD

Department of Pediatrics, Louisiana State University Health Sciences Center, Baton Rouge, Louisiana

J. D. Congeni, MD

Department of Radiology, Division of Pediatric Radiology, Baton Rouge, Louisiana

R. Brown, MD

Department of Pediatrics, Division of Gastroenterology, Baton Rouge, Louisiana

P. Tyson, MD

Department of Pediatrics, Division of Gastroenterology, Baton Rouge, Louisiana

J. Udall, MD, PhD

Department of Pediatrics, Division of Gastroenterology, Baton Rouge, Louisiana

E. Schmidt-Sommerfeld, MD, PhD

Department of Pediatrics, Division of Gastroenterology, Baton Rouge, Louisiana, eschmi{at}lsuhsc.edu

The recto-sigmoid index on barium enema may aid in the diagnosis of Hirschsprung’s disease. However, data on its reliability in different age groups are sparse. The recto-sigmoid index and transitional zone were evaluated blindly in 107 patients with diagnostic rectal suction biopsies. Patients were divided into 3 groups: neonates, infants older than 1 month, and children. The recto-sigmoid index and transitional zone agreed with the histopathologic diagnosis in 79% and 87% of the cases, respectively. Their negative predictive values reached clinical significance in infants and children but not in neonates. Their positive predictive values were not significant in any age group. The recto-sigmoid index identified 4 patients with recto-sigmoid Hirschsprung’s disease whose diagnosis was missed by evaluating the transitional zone alone.

Key Words: Hirschsprung’s disease • aganglionosis • recto-sigmoid index • barium enema

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