CT Antegrade Colonography to Assess Proctectomy and Temporary Diverting Ileostomy Complications Before Early Ileostomy Takedown in Patients With Low Rectal Endometriosis

H. Gouya, Hervé Gouya, Ammar Oudjit, Mahaut Leconte, Jöel Coste, Joël Coste, Olivier Vignaux, O. Vignaux, Bertrand Dousset, B. Dousset, Paul Legmann, P. Legmann
AJR. American journal of roentgenology · 2011 · vol. 198(1) , pp. 98–105 · doi:10.2214/ajr.10.5916 · PMID:22194484 · W2169870872
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CT antegrade colonography demonstrated high predictive values for detecting anastomotic leakage and abscesses before ileostomy takedown in patients with low rectal endometriosis.

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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. MATERIALS AND 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. CONCLUSION: 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.

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Condition tags

mesh:D004715endometriosis

MeSH descriptors

Colonography, Computed Tomographic Endometriosis Endometriosis Postoperative Complications Proctocolectomy, Restorative Rectal Diseases Rectal Diseases Abscess Abscess Adult Anastomotic Leak Anastomotic Leak Chi-Square Distribution Colonography, Computed Tomographic Contrast Media Diatrizoate Endometriosis Female Fluoroscopy Humans

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