title: Is the routine use of a water-soluble contrast enema prior to closure of a loop ileostomy necessary? A review of a single institution experience.
abstract: BACKGROUND
  The aims of the study were to determine the radiological leak rate in those patients who had undergone a resection for left-sided colorectal cancer and to see if the presence of a leak can be related with the postoperative clinical period. We also aimed to identify any common factors between patients with leak.
  
  
  METHODS
  A retrospective analysis of prospectively collected data of all patients who underwent a left-sided colorectal cancer resection with formation of a defunctioning ileostomy was undertaken. Between 2005 and 2010, 418 such patients were identified.
  
  
  RESULTS
  A water-soluble contrast enema was performed in 339 patients (81.1 %). Of these, 24 (7.1 %) were reported to show an anastomotic leak. Data for these 24 patients is presented in this study. Twenty-three (95.8 %) of the leaks occurred in patients who had undergone an anterior resection; 95.8 % of the patients with a leak were male. Fifteen (62.5 %) patients underwent neo-adjuvant radiation. The mean length of stay in those patients shown to have a subsequent radiological leak was 18.8 days (median), compared with the overall unit figures of 12 days. Only 29.2 % of the patients who had a leak identified had an uncomplicated postoperative period. Overall 87.5 % of the patients had a reversal of the ileostomy.
  
  
  CONCLUSIONS
  Radiological leakage is not uncommon. The majority of patients, who were shown to have a radiological leak in this study, were male, had undergone an anterior resection, had received neo-adjuvant radiation, had a longer initial length of stay and had postoperative complications. Water-soluble contrast enemas could be selectively used in patients with these characteristics.
authors.affiliation: Colorectal Department, Leicester Royal Infirmary, Leicester, UK. nicdem_gr@hotmail.com.|, 26, Mikras Asias str, Athens, 11527, Greece. nicdem_gr@hotmail.com.
authors.forename: Nikoletta
authors.initials: N
authors.lastname: Dimitriou
authors.affiliation: Colorectal Department, Leicester Royal Infirmary, Leicester, UK. sofoklis_p@hotmail.com.
authors.forename: Sofoklis
authors.initials: S
authors.lastname: Panteleimonitis
authors.affiliation: Colorectal Department, Leicester Royal Infirmary, Leicester, UK. ajitdhillon@doctors.org.uk.
authors.forename: Ajit
authors.initials: A
authors.lastname: Dhillon
authors.affiliation: Colorectal Department, Leicester Royal Infirmary, Leicester, UK. kirsten.boyle@uhl-tr.nhs.uk.
authors.forename: Kirsten
authors.initials: K
authors.lastname: Boyle
authors.affiliation: Colorectal Department, Leicester Royal Infirmary, Leicester, UK. mike.norwood@uhl-tr.nhs.uk.
authors.forename: Mike
authors.initials: M
authors.lastname: Norwood
authors.affiliation: Colorectal Department, Leicester Royal Infirmary, Leicester, UK. david.hemingway@uhl-tr.nhs.uk.
authors.forename: David
authors.initials: D
authors.lastname: Hemingway
authors.affiliation: Colorectal Department, Leicester Royal Infirmary, Leicester, UK. Justin.Yeung@uhl-tr.nhs.uk.
authors.forename: Justin
authors.initials: J
authors.lastname: Yeung
authors.affiliation: Colorectal Department, Leicester Royal Infirmary, Leicester, UK. andrew.miller@uhl-tr.nhs.uk.
authors.forename: Andrew
authors.initials: A
authors.lastname: Miller
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000379:methods*; D057868:Anastomotic Leak; D003287:Contrast Media / Q000008:administration & dosage*; D004733:Enema / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007081:Ileostomy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011183:Postoperative Complications; D011379:Prognosis; D011446:Prospective Studies; D011860:Radiography, Abdominal / Q000379:methods*; D012004:Rectal Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*; D012189:Retrospective Studies
chemical_list: D003287:Contrast Media