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THE ROENTGENOLOGIC APPEARANCE OF POSTOPERATIVE CONGENITAL MEGACOLON (HIRSCHSPRUNG’S DISEASE)

A. E. JAMES JR. M.D.1, J. B. GREENFIELD M.D.2, R. C. PFISTER M.D.3, A. L. WEBER M.D.4, W. H. HENDREN M.D.5, and E. B. D. NEUHAUSER M.D.6

1 Advanced Academic Fellow of the James Picker Foundation on recommendation of NRC-NAS. Department of Radiology, Johns Hopkins Medical School; Department of Radiological Sciences, Johns Hopkins School of Hygiene and Public Health, Baltimore, Maryland. Formerly: Harvard Teaching Fellow, Chief Resident in Radiology, Massachusetts General Hospital, Boston, Massachusetts.
2 Chief Resident in Radiology, New England Medical Center Hospitals, Boston, Massachusetts. Formerly: Resident, Boston Children’s Hospital, Boston, Massachusetts.
3 Department of Radiology, Massachusetts General Hospital; Instructor in Radiology, Harvard Medical School, Boston, Massachusetts.
4 Department of Radiology, Massachusetts General Hospital; Clinical Associate in Radiology, Harvard Medical School, Boston, Massachusetts.
5 Pediatric Surgeon, Massachusetts General Hospital; Assistant Clinical Professor of Surgery, Harvard Medical School, Boston, Massachusetts.
6 Chairman, Department of Radiology, Boston Children’s Hospital; Clinical Professor of Radiology, Harvard Medical School, Boston, Massachusetts.

The primary treatment of congenital megacolon is definitive surgery. Of the various operative modifications that have been described, the 3 basic techniques are the Swenson "pull through," the Duhamel, and the Soave operations.

This article describes the roentgenologic appearance of the 3 basic operations and their most common modifications.

Barium enema examination performed in a postoperative patient is an excellent method to assess the surgical correction as well as the failures and complications.

To properly evaluate postoperative Hirschsprung’s disease, the roentgenologist must be acquainted with the expected anatomic changes and their roentgenographic manifestations. The etiology of postoperative problems following surgical repair of Hirschsprung’s disease may be demonstrated by the roentgenologic principles and techniques discussed.


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