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• "Siginificant value" of CT scan in diagnosis of Hirschsprung's associated enterocolitis?
  Ronny Cheung
  Published on: 6 October 2009

• Published on: 6 October 2009

  "Siginificant value" of CT scan in diagnosis of Hirschsprung's associated enterocolitis?

  • Ronny Cheung, Paediatric SpR

  In the “Images in Paediatrics” section of ADC, Sept 2009 (1), I read with interest, and some alarm, Sheth et al.’s assertion that CT scan findings were of “significant value” in establishing the diagnosis of Hirschsprung’s associated enterocolitis.

  As the authors themselves point out, diagnosis of enterocolitis in a child with a history of endorectal pull-through operation for Hirschsprung’s disease should be m...

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  In the “Images in Paediatrics” section of ADC, Sept 2009 (1), I read with interest, and some alarm, Sheth et al.’s assertion that CT scan findings were of “significant value” in establishing the diagnosis of Hirschsprung’s associated enterocolitis.

  As the authors themselves point out, diagnosis of enterocolitis in a child with a history of endorectal pull-through operation for Hirschsprung’s disease should be made on clinical grounds, with a plain abdominal X-ray being the investigation of choice, if required. Although it appears from the clinical history that the authors give that the CT scan was performed on their patient in order to rule out intussusception - a very reasonable intervention in the circumstances– the conclusion that the authors draw in proclaiming CT scan findings to be of significant value in establishing the diagnosis of enterocolitis surely cannot be justified. In the case they describe, the CT scan was useful in ruling out diagnosis of intussusception, not in confirming the diagnosis of enterocolitis. The message from the article may be misinterpreted by practitioners who are less clinically astute than the authors as a recommendation to use CT scan, with all its inherent risks and side- effects, as a diagnostic tool of “significant value” in children with known Hirschsprung’s disease presenting in this way.

  As a general paediatrician coming across such patients in the acute setting in my practice, I would be loathe to subject my patients to the radiation, not to mention the likelihood of sedation or anaesthesia, of a CT scan which does not influence my diagnosis or management. In my non- prefessional capacity, as the parent of a 13-month old infant with Hirschsprung’s disease who has been admitted on several occasions with suspected Hirschsprung’s associated enterocolitis, I would be even more loathe to consent to such an investigation for the indications the authors seem to suggest.

  References 1. Sheth et al Images in Paediatrics “CT images of Hirschsprung’s associated enterocolitis: a rare finding. ADC 2009; 94: 816

  Competing Interests: None

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  Conflict of Interest:
  None declared.

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