Comments on the "Risk factors of bowel perforation in neonates with Hirschsprung disease".

This letter discusses methodological concerns regarding the diagnosis of pneumatosis intestinalis (PI) as an independent risk factor for bowel perforation in neonates with Hirschsprung's disease (HSCR), as presented in the study by Liu et al. (2025). The author highlights the lack of clear radiological criteria for PI diagnosis, noting that nonspecific findings (e.g., dilated bowel loops) were used without quantitative thresholds or inter-observer validation. The letter emphasizes the need for standardized diagnostic criteria, independent radiological reviews, and histopathological correlation to strengthen the study's reliability. These refinements would enhance the clinical applicability of the findings and support more accurate risk stratification for perforation in HSCR patients.