The yield of barium enema in patients undergoing inguinal hernia repair or abdominal hysterectomy.
It is the practice of some gynecologists and general surgeons to preoperatively evaluate the colon with a barium enema (BE) examination to exclude potential intestinal involvement or coexistent disease in patients undergoing pelvic or hernia operations. This practice appears to be based on anecdotal data with few studies specifically evaluating its usefulness. We retrospectively evaluated the records of 190 patients at William Beaumont Army Medical Center during 1986 to 1987 who received a preoperative BE prior to total abdominal hysterectomy (TAH) or inguinal hernia repair (IHR). The tumor registry charts of 59 patients diagnosed with carcinoma of the colon and rectum during the same period were also cross-checked to determine if any were detected during preoperative evaluation for TAH or IHR. BE findings were considered significant if they altered surgical management or asymptomatic carcinoma was detected. Of 86 patients screened before TAH by BE, eight had abnormal findings with subsequent colonoscopy revealing four with adenomatous polyps, one of which required surgical resection. Of 104 patients screened before IHR by BE, 15 had abnormal findings with subsequent colonoscopy revealing five patients with adenomatous polyps and two with adenocarcinoma. Screening preoperative BE had a low yield of clinically significant findings, which was even lower in the subgroup with carcinoma. There was no apparent relationship between findings and age in our study. Our results suggest that the use of routine preoperative BE has a low yield and should be performed only if clinical symptoms or findings suggest a need for this study.
Maccini
D M
DM
Gastroenterology Service, William Beaumont Army Medical Center, El Paso, Texas 79920-5001.
Miller
R M
RM
D000328:Adult; D000368:Aged; D001466:Barium Sulfate; D002277:Carcinoma / Q000175:diagnosis; D003110:Colonic Neoplasms / Q000175:diagnosis; D003111:Colonic Polyps / Q000175:diagnosis; D003362:Cost-Benefit Analysis; D004733:Enema / Q000191:economics*; D005069:Evaluation Studies as Topic; D005260:Female; D006552:Hernia, Inguinal / Q000601:surgery*; D006801:Humans; D007044:Hysterectomy; D008875:Middle Aged; D011300:Preoperative Care / Q000379:methods*; D012004:Rectal Neoplasms / Q000175:diagnosis; D012189:Retrospective Studies
D001466:Barium Sulfate