Ultrasonic diagnostics of Hirschsprung’s disease in adults

Aim. To study the possibilities of hydrosonography for the differential diagnosis of Hirschsprung’s disease. Methods. The results of the examination of five patients with histologically confirmed diagnosis of Hirschsprung’s disease, 19 patients with slow transit constipation and 10 healthy volunteers are presented. Rectal ultrasonography was performed after retrograde colon filling with saline. Rectal lumen width, thickness and structure of the rectal mucosa and muscular layer were evaluated. The place of transition of rectal ampoule into the anal canal was thoroughly examined to determine rectal anal inhibitory reflex. Results. The following ultrasonic signs of Hirschsprung’s disease were identified: rectal wall thickening up to 6±0,7 mm due to muscular layer hypertrophy, hyperechoic mucosa, rectal lumen widening up to 60±5 mm. A high predictive value of ultrasonography for diagnosis of rectal anal inhibitory reflex absence in Hirschsprung’s disease (sensitivity 100%, specificity 96.7%, accuracy 97.1%). Advantages of the examination are obviousness and technical simplicity. With no introduction of a balloon, electrodes or ultrasonic detector into the rectal lumen, the results of examination can hardly be biased or miscomprehended. Conclusion. Hydrosonography might be used in diagnosis of Hirschsprung’s disease, this method facilitates the differential diagnosis of Hirschsprung’s disease and other forms of chronic constipation and contributes to the correct choice of treatment strategy.

slow transit constipation, Hirschsprung’s disease, ultrasonography, rectal anal inhibitory reflex