title: CT antegrade colonography to assess proctectomy and temporary diverting ileostomy complications before early ileostomy takedown in patients with low rectal endometriosis.
abstract: OBJECTIVE
  The purpose of this study is to describe an imaging method based on a CT technique, CT antegrade colonography, for the evaluation of low anastomosis and to evaluate the value of CT antegrade colonography before early ileostomy closure after proctectomy in low rectal endometriosis.
  
  
  METHODS
  One hundred ninety-five patients referred for low rectal endometriosis underwent proctectomy and were eligible for early ileostomy closure. All patients underwent standard antegrade fluoroscopy (n=77) or CT antegrade colonography (n=118) 8 days after surgery. The negative predictive values, positive predictive values, sensitivity, specificity, and likelihood ratio of standard antegrade fluoroscopy and CT antegrade colonography in detecting anastomotic leakage and abscesses were assessed. The reference standard for positive and negative examinations was based on clinical follow-up, imaging, surgical, or interventional procedure findings.
  
  
  RESULTS
  Negative and positive predictive values for detecting anastomotic leakage were 100% (95% CI, 96.8-100%) and 100% (95% CI, 39.8-100%), respectively, for CT antegrade colonography and 98.6% (95% CI, 92.4-100%) and 100% (95% CI, 54.1-100%), respectively, for standard antegrade fluoroscopy. The negative and positive predictive values for detecting abscess were 100% (95% CI, 96.8-100%) and 100% (95% CI, 47.8-100%), respectively, for CT antegrade colonography and 97.3% (95% CI, 90.8-99.7%) and 100% (95% CI, 2.5-100%), respectively, for standard antegrade fluoroscopy.
  
  
  CONCLUSIONS
  CT antegrade colonography may play a major role in the evaluation of low anastomosis protected by an ileostomy after proctectomy in low rectal endometriosis, leading to the development of a new strategy with early restoration of the intestinal continuity.
authors.affiliation: Department of Radiology, University Paris Descartes Paris V, Cochin Hospital, Assistance Publique Hôpitaux de Paris, 27 rue du Faubourg Saint Jacques, 75014 Paris, Cedex 14, France. martinjeang@yahoo.fr
authors.forename: Hervé
authors.initials: H
authors.lastname: Gouya
authors.forename: Ammar
authors.initials: A
authors.lastname: Oudjit
authors.forename: Mahaut
authors.initials: M
authors.lastname: Leconte
authors.forename: Joël
authors.initials: J
authors.lastname: Coste
authors.forename: Olivier
authors.initials: O
authors.lastname: Vignaux
authors.forename: Bertrand
authors.initials: B
authors.lastname: Dousset
authors.forename: Paul
authors.initials: P
authors.lastname: Legmann
mesh_terms: D000038:Abscess / Q000000981:diagnostic imaging; D000328:Adult; D057868:Anastomotic Leak / Q000000981:diagnostic imaging; D016009:Chi-Square Distribution; D023881:Colonography, Computed Tomographic / Q000379:methods*; D003287:Contrast Media; D003973:Diatrizoate; D004715:Endometriosis / Q000000981:diagnostic imaging* / Q000601:surgery*; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D007081:Ileostomy; D016013:Likelihood Functions; D011183:Postoperative Complications / Q000000981:diagnostic imaging*; D011237:Predictive Value of Tests; D016737:Proctocolectomy, Restorative / Q000379:methods*; D011857:Radiographic Image Interpretation, Computer-Assisted; D012002:Rectal Diseases / Q000000981:diagnostic imaging* / Q000601:surgery*; D012189:Retrospective Studies; D012680:Sensitivity and Specificity
chemical_list: D003287:Contrast Media; D003973:Diatrizoate