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Routine contrast imaging of low pelvic anastomosis prior to closure of defunctioning ileostomy: is it necessary?

Publication ,  Journal Article
Kalady, MF; Mantyh, CR; Petrofski, J; Ludwig, KA
Published in: J Gastrointest Surg
July 2008

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.

Duke Scholars

Published In

J Gastrointest Surg

DOI

EISSN

1873-4626

Publication Date

July 2008

Volume

12

Issue

7

Start / End Page

1227 / 1231

Location

Netherlands

Related Subject Headings

  • Surgery
  • Retrospective Studies
  • Reproducibility of Results
  • Radiography, Abdominal
  • Proctocolectomy, Restorative
  • Middle Aged
  • Male
  • Ileostomy
  • Humans
  • Follow-Up Studies
 

Citation

APA
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ICMJE
MLA
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Kalady, M. F., Mantyh, C. R., Petrofski, J., & Ludwig, K. A. (2008). Routine contrast imaging of low pelvic anastomosis prior to closure of defunctioning ileostomy: is it necessary? J Gastrointest Surg, 12(7), 1227–1231. https://doi.org/10.1007/s11605-008-0510-2
Kalady, Matthew F., Christopher R. Mantyh, Jason Petrofski, and Kirk A. Ludwig. “Routine contrast imaging of low pelvic anastomosis prior to closure of defunctioning ileostomy: is it necessary?J Gastrointest Surg 12, no. 7 (July 2008): 1227–31. https://doi.org/10.1007/s11605-008-0510-2.
Kalady MF, Mantyh CR, Petrofski J, Ludwig KA. 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.
Kalady, Matthew F., et al. “Routine contrast imaging of low pelvic anastomosis prior to closure of defunctioning ileostomy: is it necessary?J Gastrointest Surg, vol. 12, no. 7, July 2008, pp. 1227–31. Pubmed, doi:10.1007/s11605-008-0510-2.
Kalady MF, Mantyh CR, Petrofski J, Ludwig KA. Routine contrast imaging of low pelvic anastomosis prior to closure of defunctioning ileostomy: is it necessary? J Gastrointest Surg. 2008 Jul;12(7):1227–1231.
Journal cover image

Published In

J Gastrointest Surg

DOI

EISSN

1873-4626

Publication Date

July 2008

Volume

12

Issue

7

Start / End Page

1227 / 1231

Location

Netherlands

Related Subject Headings

  • Surgery
  • Retrospective Studies
  • Reproducibility of Results
  • Radiography, Abdominal
  • Proctocolectomy, Restorative
  • Middle Aged
  • Male
  • Ileostomy
  • Humans
  • Follow-Up Studies