Water soluble contrast enema examination of the integrity of the rectal anastomosis prior to loop ileostomy reversal may be superfluous

Larsson, Anna; Lindmark, Gunilla; Syk, Ingvar; Buchwald, Pamela

doi:10.1007/s00384-014-2113-6

Cited by 16 publications

(22 citation statements)

References 18 publications

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“…26 Similarly, in a retrospective review of 95 patients, Larsson et al reported that contrast enema does not provide additional information if proctoscopy and digital rectal examination are normal. 27…”

Section: Clinical Examinationmentioning

confidence: 99%

Considerations in Stoma Reversal

Sherman

Wexner

2017

Clinics in Colon and Rectal Surgery

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Temporary stomas are frequently used in the management of diverticulitis, colorectal cancer, and inflammatory bowel disease. These temporary stomas are used to try to mitigate septic complications from anastomotic leaks and to avoid the need for reoperation. Once acute medical conditions have improved and after the anastomosis has been proven to be healed, stomas can be reversed. Contrast enemas, digital rectal examination, and endoscopic evaluation are used to evaluate the anastomosis prior to reversal. Stoma reversal is associated with complications including anastomotic leak, postoperative ileus, bowel obstruction, enterocutaneous fistula, and, most commonly, surgical site infection. Furthermore, many stomas, which were intended to be temporary, may not be reversed due to postoperative complications, adjuvant therapy, or prohibitive comorbidities.

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Section: Clinical Examinationmentioning

confidence: 99%

Considerations in Stoma Reversal

Sherman

Wexner

2017

Clinics in Colon and Rectal Surgery

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“…Despite awareness that a small cohort might not be able to demonstrate strong correlation between morphology in radiology and treatment outcomes, the study has been conducted for exploratory purposes as a basis for future work. The general value of CE in diagnosing AL after AR has previously been challenged, primarily regarding its use as a routine investigation before reversal of defunctioning stoma (7,24,25). The location of AL after sideto-end anastomosis, i.e.…”

Section: Discussionmentioning

confidence: 99%

Radiological findings in anastomotic leakage after anterior resection may predict a permanent stoma

Jutesten

Lydrup

Landberg

et al. 2020

Acta Radiologica Open

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Background: Permanent stoma (PS) is common following treatment of anastomotic leakage (AL) after anterior resection (AR) and ways of predicting successful treatment outcome are missing. Purpose: To explore radiological variables in rectal contrast studies in their relation to end-result of PS following treatment for AL after AR. Material and Methods: The Swedish Cancer Registry (SCRCR) was explored for AL cases after AR for rectal cancer in patients operated in the region of Skåne from 1 January 2001 to 31 December 2011. Among identified AL cases, patients subjected to radiological imaging consistent with AL were evaluated according to a predetermined set of radiological variables. Information of PS as the end-result after AL treatment were retrieved from medical records. Results: Thirty-two patients had radiological imaging available for analysis confirming AL after AR; PS rate after a median follow-up of 87 months (range ¼ 21-165) after AR was 62%. Radiological findings compatible with abscess (P ¼ 0.023) and a leak size 6 mm (P ¼ 0.049) were significantly associated with PS. Conclusion: In this limited explorative study, our findings suggest that abscess status and leak size could correspond to outcome of PS in treatment for AL after AR. Additional studies are warranted to further explore this subject.

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“…Water‐soluble contrast enemas (WSCEs) are a frequently used investigation method to assess anastomotic integrity and have been shown to be superior to computed tomography imaging for distal anastomoses . In recent years, there has been much debate regarding the routine use of WSCEs to assess anastomotic integrity compared to a simple digital rectal examination . However, these studies have focused predominantly on cases following resection for colorectal cancer, with limited data in noncancer resections.…”

Section: Introductionmentioning

confidence: 99%

Is water‐soluble contrast enema examination for integrity of rectal anastomosis necessary prior to ileostomy reversal?

et al. 2019

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Background and Aim Routine use of water‐soluble contrast enema (WSCE) to assess anastomotic integrity is debated. This study aimed to evaluate the role of WSCE to assess anastomotic integrity following anterior resections (AR) with defunctioning stoma prior to reversal and identify factors to limit its selective use. Methods This retrospective study evaluated all WSCE performed over a 7‐year period at a high‐volume colorectal unit. Risk factors for radiological abnormality/leak, including malignancy, chemoradiotherapy, and immediate postoperative complications, were recorded. A gastrointestinal specialist radiologist and surgeon validated all WSCEs reported as abnormal. Results Of the 486 WSCE studies identified, 92 were excluded (repeat studies (n = 51), pediatric cases [n = 2], no AR [n = 39]). A total of 394 WSCE studies were evaluated (260 cancer; 134 noncancer patients); 14% (37/260) of cancer patients and 8% (10/134) of noncancer patients had abnormal studies (P = 0.072). Of the 37 abnormal studies in cancer patients, 73% (27/37) radiological leaks were found, and 41% (n = 11/27) of these patients had postoperative complications. Of the 10 abnormal studies in noncancer patients, 20% (2/10) radiological leaks were found, but none of these patients had postoperative complications. Overall leak rates were 7% (29/394), and rates were significantly higher in cancer patients than noncancer patients (10 vs 2%, P = 0.005). Conclusion Routine use of WSCE may not be necessary prior to reversal. WSCE should be selectively used in event of postoperative leak or complications. Noncancer resections are less likely demonstrate a leak.

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Water soluble contrast enema examination of the integrity of the rectal anastomosis prior to loop ileostomy reversal may be superfluous

Abstract: This retrospective study indicates that contrast enema does not provide additional information if rectoscopy and DRE are normal. Despite negative examinations, three of nine leakages were diagnosed after loop ileostomy reversal. Especially, AVFs seem difficult to diagnose.

Cited by 16 publications

References 18 publications

Considerations in Stoma Reversal

Considerations in Stoma Reversal

Radiological findings in anastomotic leakage after anterior resection may predict a permanent stoma

Is water‐soluble contrast enema examination for integrity of rectal anastomosis necessary prior to ileostomy reversal?

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