Annals of Coloproctology

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Original Article

Assessment by Using a Water-Soluble Contrast Enema Study of Radiologic Leakage in Lower Rectal Cancer Patients With Sphincter-Saving Surgery: Seok In Seo, Jong Lyul Lee, Seong Ho Park, Hyun Kwon Ha, Jin Cheon Kim; Ann Coloproctol. 2015;31(4):131-137. Published online August 31, 2015; DOI: https://doi.org/10.3393/ac.2015.31.4.131

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11 Citations

Purpose

This study evaluated the efficacy of a water-soluble contrast enema (WCE) in predicting anastomotic healing after a low anterior resection (LAR).

Methods

Between January 2000 and March 2012, 682 consecutive patients underwent a LAR or an ultra-low anterior resection (uLAR) and were followed up for leakage. Clinical leakage was established by using physical and laboratory findings. Radiologic leakage was identified by using retrograde WCE imaging. Abnormal radiologic features on WCE were categorized into four types based on morphology: namely, dendritic, horny, saccular, and serpentine.

Results

Of the 126 patients who received a concurrent diverting stoma, only two (1.6%) suffered clinical leakage due to pelvic abscess. However, 37 patients (6.7%) in the other group suffered clinical leakage following fecal diversion (P = 0.027). Among the 163 patients who received a fecal diversion, 20 showed radiologic leakage on the first WCE (eight with and 12 without a concurrent diversion); 16 had abnormal features continuously until the final WCE while four patients healed spontaneously. Eleven of the 16 patients (69%), by their surgeon's decision, underwent a stoma restoration based on clinical findings (2/3 dendritic, 3/4 horny, 5/7 saccular, 1/2 serpentine). After stoma reversal, only 2 of the 11 (19%) complained of complications related to the rectal anastomosis.

Conclusion

WCE is helpful for detecting radiologic leakage before stoma restoration, especially in patients suffering clinical leakage after an uLAR. However, surgeons appear to opt for stoma restoration despite the persistent existence of radiologic leakage in cases with particular features on the WCE.

Citations

Citations to this article as recorded by

Preoperative anastomotic evaluation prior to ileostomy closure: A 5‐year UK survey, systematic review, and meta‐analysis
D. Atraszkiewicz, T. Shakir, C. Harrington, P. Bassett, B. Soile, H. Mukhtar
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International Journal of Colorectal Disease.2021; 36(11): 2387. CrossRef
Radiological findings in anastomotic leakage after anterior resection may predict a permanent stoma
Henrik Jutesten, Marie-Louise Lydrup, Axel Landberg, Daniel Risberg, Olle Ekberg, Sophia Zackrisson, Pamela Buchwald
Acta Radiologica Open.2020;[Epub] CrossRef
Are radiologic pouchogram and pouchoscopy useful before ileostomy closure in asymptomatic patients operated for ulcerative colitis?
Georgios Exarchos, Linda Metaxa, Antonios Gklavas, Vassilis Koutoulidis, Ioannis Papaconstantinou
European Radiology.2019; 29(4): 1754. CrossRef
Surgical specimen extraction via a prophylactic ileostomy procedure: A minimally invasive technique for laparoscopic rectal cancer surgery
Peng Wang, Jian-Wei Liang, Hai-Tao Zhou, Zheng Wang, Zhi-Xiang Zhou
World Journal of Gastroenterology.2018; 24(1): 104. CrossRef
Imaging of the Postoperative Colon
Eugene Huo, Laura Eisenmenger, Stefanie Weinstein
Radiologic Clinics of North America.2018; 56(5): 835. CrossRef
Should a Contrast Enema Be Performed Before Reversal of a Diverting Stoma in Lower Rectal Surgery?
Ji Yeon Kim
Annals of Coloproctology.2015; 31(4): 117. CrossRef

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