Diagnostic significance of microcolon findings in neonatal contrast enema for patients with intestinal atresia.

PURPOSE: This study aimed to investigate the microcolon cutoff value for diagnosing intestinal atresia using a neonatal contrast enema.

METHODS

A 20-year retrospective review of contrast enema images of neonates ≤ 4 days of age with abdominal distension was performed. The patients were categorized into five groups: intestinal atresia, meconium ileus, normal, Hirschsprung disease, and others. The maximum diameter of each part of the colon was measured when the splenic flexure, hepatic flexure, or terminal ileum was visualized. Receiver operating characteristic analysis was performed to determine the optimal cutoff value of the colonic diameter (CD) to L1 interpedicular distance (IPD) ratio for predicting intestinal atresia.

RESULTS

The area under the curve (AUC) for the diagnostic performance of the CD/IPD ratio for intestinal atresia exceeded 0.8 in all colon parts at all time points. The AUC for the ascending CD/IPD at the time of terminal ileum visualization was the highest (0.907), and its optimal cutoff value was 0.955 (sensitivity, 90.9%; specificity, 84.4%).

CONCLUSION

An ascending CD less than the L1 IPD at the time of terminal ileum visualization on neonatal contrast enema should be considered indicative of a microcolon in small intestinal atresia.