title: CT colonography in patients who have undergone sigmoid colostomy: a feasibility study.
abstract: OBJECTIVE
  The purpose of this study was to evaluate the technical feasibility of CT colonography of patients who have undergone sigmoid colostomy after abdominoperineal resection.
  
  
  METHODS
  Seven men and 11 women (mean age, 57.2 ± 14.5 [SD] years) who had undergone abdominoperineal resection with sigmoid colostomy for rectal cancer were included. Colonic cleansing and fecal tagging were performed with magnesium citrate and 5% weight/volume barium. A conventional small rectal catheter with a retention balloon was introduced into the colonic stoma. An inflated balloon (15-25 mL) was positioned several centimeters beneath the skin. The interposed tissue acted as the mechanism for preventing balloon expulsion during colonic insufflation with carbon dioxide. Unenhanced right decubitus and contrast-enhanced supine images were obtained. Air-fluid leak, balloon expulsion, complications, and colonic distention evaluated on a 4-point scale in which 1 was the worst and 4 the best and mucosal coverage were assessed.
  
  
  RESULTS
  Examinations were performed uneventfully for all but one patient, who had temporary air and fluid leakage. The mean amount of carbon dioxide used was 2.64 ± 0.64 L. In the right decubitus position, the mean distention grade of each colonic segment was 2.7 ± 1.1 (sigmoid), 3.4 ± 0.6 (descending), 3.6 ± 0.5 (transverse), 3.6 ± 0.5 (ascending), and 3.7 ± 0.5 (cecum). In the supine position the mean grades were 2.7 ± 1.2, 3.1 ± 0.7, 3.7 ± 0.5, 3.7 ± 0.5, and 3.8 ± 0.4. Four patients (22.2%) had segments not adequately visualized in either position owing to luminal collapse; all of these segments were in the sigmoid colon. Three patients (16.7%) had areas submerged under fecal matter in both positions, but these areas were evaluable because of fecal tagging or IV contrast enhancement.
  
  
  CONCLUSIONS
  CT colonographic examination through a sigmoid stoma was technically feasible with currently available instruments, but further improvements in technique are needed.
authors.affiliation: Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Asanbyeongwon-gil 86, Songpa-Gu, Seoul 138-736, Korea.
authors.forename: Ju Hee
authors.initials: JH
authors.lastname: Lee
authors.forename: Seong Ho
authors.initials: SH
authors.lastname: Park
authors.forename: Seung Soo
authors.initials: SS
authors.lastname: Lee
authors.forename: Ah Young
authors.initials: AY
authors.lastname: Kim
authors.forename: Jin Cheon
authors.initials: JC
authors.lastname: Kim
authors.forename: Chang Sik
authors.initials: CS
authors.lastname: Yu
authors.forename: Hyun Kwon
authors.initials: HK
authors.lastname: Ha
mesh_terms: D000368:Aged; D001466:Barium Sulfate; D023881:Colonography, Computed Tomographic / Q000379:methods*; D003125:Colostomy; D003287:Contrast Media; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007327:Insufflation / Q000379:methods; D008297:Male; D008875:Middle Aged; D012004:Rectal Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery*; D012812:Sigmoidoscopy / Q000379:methods*; D018709:Statistics, Nonparametric
chemical_list: D003287:Contrast Media; D001466:Barium Sulfate