1. 2003-12-11 4149684, 신 O 용,M/0

2. 2003-12-16

3. 2003-12-17 2003-12-24

4. 2004-01-01 2004-01-07 POD#1POD#7

5. Radiologic review of Hirschsprung’s disease

6. Functional disorders of the colon Radiologic findings 1.Constipation, 1.Constipation, 2.Obstruction, 2.Obstruction, 3.Both without a mechanical defect 3.Both without a mechanical defect

7. Colonic Aganglinosis (Hirschsprung’s disease) Plain films Plain films Obstruction site Obstruction site Distal colonic obstruction : typical Distal colonic obstruction : typical Proximal colon : Partial small bowel obstruction -confuse Proximal colon : Partial small bowel obstruction -confuse Stool Content Stool Content Extensive amounts : Proximal dilated colon. Extensive amounts : Proximal dilated colon. Empty of stool : Distal colon Empty of stool : Distal colon Immediately after contrast enema Immediately after contrast enema Distended bowel loops fill almost Distended bowel loops fill almost Delayed films Delayed films Delayed evacuation of barium :Retention at 48hrs Delayed evacuation of barium :Retention at 48hrs Mixed barium-stool pattern Mixed barium-stool pattern

8. Contrast Study Contrast agents Contrast agents Barium or Water-soluble Barium or Water-soluble Water-soluble media : more commonly used Water-soluble media : more commonly used Retain barium for extended periods of time Retain barium for extended periods of time Therapeutic if functional constipation. Therapeutic if functional constipation.

9. Preparation Do not Do not :Presence of stool in the dilated portion of the bowel the :Presence of stool in the dilated portion of the bowel the - Identification of a Transition zone easier. - Identification of a Transition zone easier.

10. Findings Transion zone : rectosigmoid Transion zone : rectosigmoid Between narrowed,stool-free aganglionic distal segment Between narrowed,stool-free aganglionic distal segment and dilated,stool-filled proximal segment. and dilated,stool-filled proximal segment. Thickening and nodularity of colonic mucosa Thickening and nodularity of colonic mucosa on Proximal to transition zone.(rare) on Proximal to transition zone.(rare) Abnormal irregular contraction waves (20%) Abnormal irregular contraction waves (20%) Smooth or Spiky Smooth or Spiky

11. Contraindication Hirschsprung-associated enterocolitis Hirschsprung-associated enterocolitis Sx. & Sign : Fever,abdominal distention,diarrhea,and sepsis. Sx. & Sign : Fever,abdominal distention,diarrhea,and sepsis. Water-soluble contrast enemas Water-soluble contrast enemas Findings Findings Plain films Plain films Intestinal distention with air-fluid levels Intestinal distention with air-fluid levels Look for evidence of intestinal perforation Look for evidence of intestinal perforation US US Thickened bowel wall and ascites. Thickened bowel wall and ascites.