Ref Number = PITIKA-ASPR0402
Tisa Paramita, HF Wulandari, Evita KB Ifran
Objective: to show that the transition zone in contrast enema examination may lead to other diagnosis than Hirschprung’s disease.
Case: A two months old boy suspected with Hirschprung’s disease was referred for a contrast enema examination. He was born with normal gestational age. He has a history of shortness of breath, without delayed passage of meconium in 24 hours, and non-frequent diarrhea. He was constipated during his first month and has regular defecation currently. He has a normal weight increment and fed with formula milk. Distended abdomen was encountered in physical examination. Plain abdominal x-ray showed dilatation of descending colon. Contrast enema examination revealed transition zone in the rectum without antiperistaltic motion in the 24 hours-delayed abdominal x-ray.

Conclusion: Although the image in contrast enema examination shows a transition zone, the history of this patient is incongruent with Hirschprung’s disease. An extra attention on the history of the patient should always be taken in diagnosing of Hirschprung’s disease. This condition is also supported by the absence of antiperistaltic motion in the 24 hours-delayed abdominal x-ray. Other diseases such as allergic colitis, or salmonella colitis may be one of the diagnosis. 
Keywords: transition zone, contrast enema, Hirschprung’s disease, allergic colitis, salmonella colitis
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