Barium enema is the mainstay of Hirschsprung’s disease diagnosis. Barium enema findings suggestive of Hirschsprung’s disease include a transition zone between the narrow and dilated portions of the colon in the shape of an inverted cone, which is the most characteristic radiologic finding.

• Barium enema studies demonstrate patency of the colon, which is short but usually normal in caliber.
• A transition zone between the narrow and dilated portions of the colon in the shape of an inverted cone is the most characteristic radiologic finding.
• When this transition zone is observed, the examination should be discontinued because filling of proximal dilated bowel beyond the transition zone may lead to impaction.
• Radiologic diagnosis of total colonic aganglionosis is difficult. Findings from barium enema examination may be normal or may show a short colon of normal caliber, microcolon, or a transition zone in the ileum.^[1]

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  Case courtesy of Radswiki, Radiopaedia.org, rID: 11495
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  Case courtesy of Radswiki, Radiopaedia.org, rID: 11495
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  Case courtesy of Radswiki, Radiopaedia.org, rID: 11495
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  Case courtesy of Radswiki, Radiopaedia.org, rID: 11495