Faculty Collaboration Database

Routine contrast imaging of low pelvic anastomosis prior to closure of defunctioning ileostomy: is it necessary? J Gastrointest Surg 2008 Jul;12(7):1227-31

Date

03/28/2008

Pubmed ID

18368457

DOI

10.1007/s11605-008-0510-2

Scopus ID

2-s2.0-46249100173 (requires institutional sign-in at Scopus site)   44 Citations

Abstract

PURPOSE: The purpose of the study was to determine the utility of routine contrast enema prior to ileostomy closure and its impact on patient management in patients with a low pelvic anastomosis.

MATERIAL AND METHODS: Two hundred eleven patients had a temporary loop ileostomy constructed to protect a low colorectal or coloanal anastomosis following low anterior resection for cancer (57%) or other disease (12%) or to protect an ileal pouch-anal anastomosis following restorative proctocolectomy (31%). All patients were evaluated by physical examination, proctoscopy, and water-soluble contrast enema prior to ileostomy closure. Imaging results were correlated with the clinical situation to determine the effects on patient management.

RESULTS: The mean time from ileostomy creation to closure was 15.6 weeks. Overall, 203 patients (96%) had an uncomplicated course. Eight patients (4%) developed an anastomotic leak, seven of which were diagnosed clinically and confirmed radiographically before planned ileostomy closure. Resolution of the leak was confirmed by follow-up contrast enema. One patient, whose pouchogram revealed a normal anastomosis, clinically developed a leak after ileostomy closure. It is important to note that routine contrast enema examination did not reveal an anastomotic leak or stricture that was not already suspected clinically.

CONCLUSIONS: All patients who developed an anastomotic leak in this study were diagnosed clinically, and the diagnosis was confirmed by selective use of radiographic tests. Routine contrast enema evaluation of low pelvic anastomoses before loop ileostomy closure did not provide any additional information that changed patient management. The utility of this routine practice should be questioned.

Author List

Kalady MF, Mantyh CR, Petrofski J, Ludwig KA

Author

Kirk A. Ludwig MD Chief, Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adolescent
Adult
Aged
Aged, 80 and over
Anal Canal
Anastomosis, Surgical
Colon
Colonic Diseases
Contrast Media
Diatrizoate Meglumine
Enema
Female
Follow-Up Studies
Humans
Ileostomy
Male
Middle Aged
Proctocolectomy, Restorative
Radiography, Abdominal
Reproducibility of Results
Retrospective Studies