Use Of Barium Enema In Neonates With Suspected Hirschsprung Disease: A Narrative Review

Abstract

Background: Hirschsprung's disease (HD) is one of the most prevalent causes of intestinal obstruction in children. Although there are several ways to diagnose Hirschsprung's disease, barium enema is the most common first diagnostic approach. During the first month of life, radiographic pictures of the colon obtained with a barium enema frequently appear normal, and in patients with complete colonic involvement, they may remain normal indefinitely.

Methodology: To diagnose Hirschsprung's disease in neonatal patients who have received a barium enema, this review looks at recent updates on barium enema in the diagnosis of Hirschsprung’s disease in neonates. A search was made on Google Scholar, PubMed, Medline, Hinari, ResearchGate, ScienceDirect, using ‘barium enema’, ‘Hirschsprung’s disease’ and ‘neonates’ as search terms from 2005 to 2025. Retrieved data were entered into an online Google form and transferred to an Excel sheet. A review of relevant full articles was subsequently done. Articles not published in English Language, those published outside the neonatal period and in adults were excluded.

Results: The rectosigmoid index is a clear way to aid in the diagnosis of rectosigmoid Hirschsprung disease in newborns, especially when the radiographic images are unclear or hard to read. The presence of recto-sigmoid index and three radiographic signs - rectosigmoid transition zone, barium retention, and stool mixed with barium - strongly indicates the condition.

Conclusion: Barium enema is an easy way to diagnose Hirschsprung’s disease in neonates particularly in resource poor settings.