J Korean Surg Soc.  2012 Aug;83(2):88-91. 10.4174/jkss.2012.83.2.88.

Routine barium enema prior to closure of defunctioning ileostomy is not necessary

• Hong SY
• Kim DY
• Oh SY
• Suh KW

• KMID: 1820092
• DOI: http://doi.org/10.4174/jkss.2012.83.2.88

Abstract

PURPOSE
The use of barium enemas to confirm the anastomotic integrity prior to ileostomy closure is still controversial. 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.
METHODS
One hundred forty-five patients had a temporary loop ileostomy constructed to protect a low colorectal or coloanal anastomosis following low anterior resection for rectal cancer. All patients were evaluated by physical examination, proctoscopy, and barium enema prior to ileostomy closure.
RESULTS
The median time from ileostomy creation to closure was 8 months. Five (3.5%) of the 144 patients were found to have clinically relevant strictures at the colorectal anastomosis on routine barium enema. One patient (0.7%) showed anastomotic leak on their barium enema. Overall, 141 patients (97.9%) had an uncomplicated postoperative course. Postoperative complication occurred in three patients (2.1%). None of them showed abnormal barium enema finding, which suggested that routine contrast enema examination did not predict postoperative complication.
CONCLUSION
Routine barium enema evaluation of low pelvic anastomoses before loop ileostomy closure did not provide any additional information for postoperative colorectal anastomotic complication.

Keyword

Ileostomy closure; Protective ileostomy; Barium enema; Anastomotic leak

MeSH Terms

Anastomotic Leak
Barium
Constriction, Pathologic
Enema
Humans
Ileostomy
Physical Examination
Postoperative Complications
Proctoscopy
Rectal Neoplasms
Barium

Figure

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  Fig. 1 (A) A 64-year-old man with stricture at colorectal anastomosis after low anterior resection for rectal cancer. (B) A 52-year-old man with fistula at rectal stump after low anterior resection for rectal cancer.

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