title: Preoperative distal loop contrast radiograph before closure of an enterostomy in paediatric surgical patients. How much does it affect the procedure or predict early postoperative complications?
abstract: Before the closure of an enterostomy, a distal loop contrast radiograph (DLCR) is widely used to disclose pathology which may affect the performance of the procedure. We studied whether DLCR of paediatric patients caused actual alterations in the surgical plan and whether it predicted postoperative complications. Between 1991 and 2006, 105 patients (small bowel enterostomy, SBE; n = 51), (colostomy, CO; n = 54) underwent closure of an enterostomy. All 105 patients had preoperative DLCR. The indications for enterostomy included anorectal malformation (n = 38), neonatal intestinal perforation (n = 25), J-Pouch ileoanal anastomosis (n = 20), anorectal trauma (n = 5), and miscellaneous (n = 17). We recorded sensitivity, specificity, and positive and negative predictive value (PPV and NPV) of DLCR for complications within 6 postoperative weeks. DLCR was considered complete and interpreted as normal in 94 (90%) and abnormal (incomplete n = 3 or pathological n = 8) in 11 (10%) patients. None of the 11 abnormal findings caused cancellation of surgery, but in three (27%) patients it was possible to surgically correct a stricture seen in DLCR. The frequency of surgical complications was 17/105 (16%), SBE (15/51,29%) and CO (2/54, 4%), (P < 0.05). Most common complications (9/17, 53%) were those associated with the intestinal anastomosis. For postoperative complications DLCR had sensitivity, specificity, and PPV and NPV of 47, 97, 73 and 90% (SBE and 47, 97, 88 and 81%), (CO 50, 96, 33 and 98%). The pathology seen in DLCR, however, seldom directly hinted the complications which actually occurred. Abnormal DLCR changed the surgical plan in less than one-fifth of the cases. For surgical complications DLCR had poor sensitivity, good specificity and NPV, and moderate PPV. The pathology suggested by DLCR, however, correlated poorly with the actual complications. Poor sensitivity reflects the high frequency of anastomotic complications, which are practically unpredictable by preoperative radiographs.
authors.affiliation: Hospital for Children and Adolescents, University of Helsinki, Helsinki, Finland. antti.koivusalo@hus.fi
authors.forename: A
authors.initials: A
authors.lastname: Koivusalo
authors.forename: M
authors.initials: M
authors.lastname: Pakarinen
authors.forename: H
authors.initials: H
authors.lastname: Lindahl
authors.forename: R J
authors.initials: RJ
authors.lastname: Rintala
mesh_terms: D000714:Anastomosis, Surgical; D003287:Contrast Media; D013505:Digestive System Surgical Procedures; D004766:Enterostomy; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007422:Intestines / Q000000981:diagnostic imaging* / Q000601:surgery*; D008297:Male; D011183:Postoperative Complications / Q000517:prevention & control; D011237:Predictive Value of Tests; D011300:Preoperative Care; D011859:Radiography / Q000379:methods*; D012189:Retrospective Studies
chemical_list: D003287:Contrast Media