Diagnostic Evaluation

Barium Enema
A barium enema is a rectal infusion of barium given to coat the lining of the colon and rectum. It is done before x-rays are taken in order to create better x-ray images of the lower intestine. Barium is a milky fluid that absorbs x-rays. Demonstrates the transition zone between the dilated proximal colon (mega colon) and the aganglionic distal segment. However, this typical mega colon and narrow distal segment may not develop until the age of 2 months or later

Rectal Biopsy
to confirm diagnosis performed either surgically to obtain a fullthickness biopsy specimen or by suction biopsy for histologic evidence of the absence of ganglion cells

Types
Suction rectal Biopsy Open rectal biopsy

Anorectal Manometry
non-invasive procedure where a catheter with a balloon attached is inserted into the rectum records reflex pressure of the internal anal sphincter to distension of the balloon Normal response: relaxation of internal sphincter followed by contraction of external sphincter (+) Hirschsprungs disease: external sphincter contracts normally but internal sphincter fails to relax