title: Assessment by Using a Water-Soluble Contrast Enema Study of Radiologic Leakage in Lower Rectal Cancer Patients With Sphincter-Saving Surgery.
abstract: OBJECTIVE
  This study evaluated the efficacy of a water-soluble contrast enema (WCE) in predicting anastomotic healing after a low anterior resection (LAR).
  
  
  METHODS
  Between January 2000 and March 2012, 682 consecutive patients underwent a LAR or an ultra-low anterior resection (uLAR) and were followed up for leakage. Clinical leakage was established by using physical and laboratory findings. Radiologic leakage was identified by using retrograde WCE imaging. Abnormal radiologic features on WCE were categorized into four types based on morphology: namely, dendritic, horny, saccular, and serpentine.
  
  
  RESULTS
  Of the 126 patients who received a concurrent diverting stoma, only two (1.6%) suffered clinical leakage due to pelvic abscess. However, 37 patients (6.7%) in the other group suffered clinical leakage following fecal diversion (P = 0.027). Among the 163 patients who received a fecal diversion, 20 showed radiologic leakage on the first WCE (eight with and 12 without a concurrent diversion); 16 had abnormal features continuously until the final WCE while four patients healed spontaneously. Eleven of the 16 patients (69%), by their surgeon's decision, underwent a stoma restoration based on clinical findings (2/3 dendritic, 3/4 horny, 5/7 saccular, 1/2 serpentine). After stoma reversal, only 2 of the 11 (19%) complained of complications related to the rectal anastomosis.
  
  
  CONCLUSIONS
  WCE is helpful for detecting radiologic leakage before stoma restoration, especially in patients suffering clinical leakage after an uLAR. However, surgeons appear to opt for stoma restoration despite the persistent existence of radiologic leakage in cases with particular features on the WCE.
authors.affiliation: Department of Surgery, Veterans Health Service Medical Center, Seoul, Korea.
authors.forename: Seok In
authors.initials: SI
authors.lastname: Seo
authors.affiliation: Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Jong Lyul
authors.initials: JL
authors.lastname: Lee
authors.affiliation: Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Seong Ho
authors.initials: SH
authors.lastname: Park
authors.affiliation: Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Hyun Kwon
authors.initials: HK
authors.lastname: Ha
authors.affiliation: Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Jin Cheon
authors.initials: JC
authors.lastname: Kim
keywords: Anastomotic leak; Colorectal surgery; Contrast radiography; Rectal neoplasms