An Analysis of Radiologic Findings and Post-operative Complications in Pediatric Patients with Hirschsprung's Disease Referred to Imam Hossein Hospital in Isfahan, Iran, Between 2017 and 2021

Purpose: Hirschsprung's disease (HD) is a congenital motor disorder that results from a lack of normal nerve cell development in the wall of the large intestine. Diagnosis of HD and management of postop complications are among the challenges of pediatric surgeons. Possible post-op complications include Adhesion, achalasia, stenosis, constipation, and fecal incontinence. Radiologic findings can help with the early diagnosis, which can improve management and decrease post-op complications. These radiologic signs include the Rectosigmoid index, Sacral index, Sacrum bone length, and Dilated segment length and diameter. This study aims to find the relation of radiologic signs, in images taken with barium enema contrast, with various post-op complications.

Methods/Materials: This is a cross-sectional study performed from March 2017 to April 2021 at Imam Hosein hospital, affiliated with Isfahan University of medical science, Isfahan, Iran. We used convenience sampling to study 30 pediatric patients diagnosed with Hirschsprung disease who underwent trans-anal pull-through surgery. Using SPSS24, we analyzed radiological findings of images taken with a barium enema and post-op complications up to 6 months after surgery.

Results: Among short-term complications, four patients had adhesion (13.3%), four patients had stenosis (13.3%), three patients had achalasia (10%), and three patients had Enterocolitis ( 10%). In terms of long-term effects, nine patients had bedsore ulcers (30%), 11 patients had constipation (36.7%), and seven patients had fecal incontinence (23.3%). Our study shows the diameter of the dilated segment has a meaningful correlation with constipation (P value = 0.030) and sacral index with stenosis (P value= 0.044). The correlation of other imaging features with post-op complications were not statistically significant.

Conclusions: This study is among the few that assessed the relationship between post-op complications of Hirschsprung's Disease with radiological findings. According to our results, the diameter of dilated segments and sacral index can predict the likelihood of constipation and stenosis, respectively, enabling doctors to manage these complications better.