Abstracts
2002 Digestive Disease Week

# 102937 Abstract ID: 102937 Routine Contrast Imaging of Low Pelvic Anastomosis before Temporary Stoma Closure: Lack of Clinical Impact on Patient Management
Matthew F Kalady, Ryan C Fields, Kirsten B Wilkins, Mark W Onaitis, Douglas S Tyler, Christopher R Mantyh, Kirk Ludwig, Durham, NC

Introduction: Loop ileostomies are frequently constructed to divert low pelvic or high-risk anastomoses. Traditionally, a contrast enema is performed prior to loop ileostomy closure to evaluate for anastomotic leak or obstruction between the stoma and the anastomosis, regardless of clinical examination. This study evaluated the utility of routine contrast enema prior to ileostomy closure and its impact on patient management. Methods: 117 patients had a temporary loop ileostomy constructed to protect a coloanal anastomosis following low anterior resection for cancer (56%) or other disease (14%), or to protect an ileal pouch-anal anastomosis following total proctocolectomy for ulcerative colitis (30%). There were 64 males and 53 females with a mean age of 52 years. All patients were evaluated by gastrograffin enema prior to ileostomy closure. The mean time from ileostomy creation to closure was 16.9 weeks. Imaging results were correlated with the clinical situation to determine the effects on patient management. Results: Overall, 111 patients (94.9%) had an uncomplicated course. Six patients (5.1%) developed an anastomotic leak, 5 of which were diagnosed clinically and confirmed radiographically long 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. Importantly, routine contrast enema examination did not reveal any anastomotic leak or bowel obstruction 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 radiography. Routine contrast enema evaluation of low pelvic anastomoses before loop ileostomy closure did not provide any additional information that changed patient management. Abandoning its routine use while only selectively utilizing contrast enema to evaluate low pelvic anastomoses before ileostomy closure will save time, money, and patient comfort.