title: The utility of routine pouchogram before ileostomy reversal in children and adolescents following ileal pouch anal anastomosis.
abstract: BACKGROUND
  Pouchograms are used to assess the integrity of the ileal pouch anal anastomosis (IPAA) in patients who have undergone restorative proctocolectomy. Its benefits have been questioned, and there are no data to support the routine use in children.
  
  
  METHODS
  We retrospectively reviewed the charts of 26 patients who had an IPAA and pouchogram at our institution between 2001 and 2009. Each patient also underwent an examination under anesthesia to assess the integrity of the IPAA on the day of the ileostomy closure.
  
  
  RESULTS
  The mean age of the patients was 13.8 (± 0.7) years. The pouchogram was performed at a median of 6 weeks after the IPAA (range, 4-20 weeks). The findings were normal in 26 (89.7%) and demonstrated stricture in 2 (6.9%) and leak in 1 (3.4%). History was suggestive and physical examination was confirmatory in these 3 problematic cases.
  
  
  CONCLUSIONS
  A contrast enema is not routinely required to evaluate the integrity of the IPAA before ileostomy reversal in pediatric patients. Complications can be detected by history and rectal examination before ileostomy closure. We recommend the use of contrast enema only in symptomatic patients where a leak is suspected, thereby limiting radiation exposure and inconvenience.
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, Colorectal Center for Children, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH 45229, USA.
authors.forename: Taiwo A
authors.initials: TA
authors.lastname: Lawal
authors.forename: Richard A
authors.initials: RA
authors.lastname: Falcone
authors.forename: Daniel
authors.initials: D
authors.lastname: von Allmen
authors.forename: Lee A
authors.initials: LA
authors.lastname: Denson
authors.forename: Marc A
authors.initials: MA
authors.lastname: Levitt
authors.forename: Brad W
authors.initials: BW
authors.lastname: Warner
authors.forename: Jason S
authors.initials: JS
authors.lastname: Frischer
mesh_terms: D000293:Adolescent; D001003:Anal Canal / Q000000981:diagnostic imaging; D000714:Anastomosis, Surgical / Q000009:adverse effects; D002648:Child; D015331:Cohort Studies; D039021:Colonic Pouches / Q000009:adverse effects*; D003251:Constriction, Pathologic / Q000000981:diagnostic imaging; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007081:Ileostomy / Q000009:adverse effects / Q000379:methods*; D007082:Ileum / Q000000981:diagnostic imaging; D008297:Male; D011300:Preoperative Care / Q000379:methods; D016737:Proctocolectomy, Restorative / Q000009:adverse effects / Q000379:methods*; D011859:Radiography; D012086:Reoperation / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D016896:Treatment Outcome