Abnormal Pouchogram Predicts Pouch Failure Even in Asymptomatic Patients
| Autor: | Neil Hyman, Konstantin Umanskiy, Philip H. Sossenheimer, Roger D. Hurst, Abraham H. Dachman, David T. Rubin, Radhika Smith, Kinga B. Skowron, Laura R. Glick, Lisa M. Cannon, Russell D. Cohen, Michele Rubin |
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| Rok vydání: | 2019 |
| Předmět: |
Adult
Male Radiography Abdominal Reoperation medicine.medical_specialty medicine.medical_treatment Colonic Pouches Contrast Media Anastomosis Asymptomatic 03 medical and health sciences Ileostomy Postoperative Complications 0302 clinical medicine Outcome Assessment Health Care medicine Humans Retrospective Studies business.industry Patient Selection Proctocolectomy Restorative Gastroenterology General Medicine Middle Aged medicine.disease Ulcerative colitis United States Extravasation Surgery Stenosis 030220 oncology & carcinogenesis Pouchogram Quality of Life Colitis Ulcerative Female 030211 gastroenterology & hepatology Pouch medicine.symptom business Extravasation of Diagnostic and Therapeutic Materials |
| Zdroj: | Diseases of the Colon & Rectum. 62:463-469 |
| ISSN: | 0012-3706 |
| Popis: | BACKGROUND Anastomotic complications after restorative total proctocolectomy with IPAA for ulcerative colitis alter functional outcomes and quality of life and may lead to pouch failure. Routine contrast enema of the pouch assesses anastomotic integrity before ileostomy reversal, but its clinical use is challenged. OBJECTIVE The purpose of this research was to assess the relationship among preoperative clinical characteristics, abnormal pouchography, and long-term pouch complications. DESIGN This was a retrospective chart review. SETTINGS The study was conducted at a tertiary care center between 2000 and 2010. PATIENTS Ulcerative colitis patients with IPAA undergoing pouchography before ileostomy closure were included. MAIN OUTCOME MEASURES Patient demographics, incidence of pouch-related complications, and findings on pouchogram were recorded. Primary outcome was pouch failure, defined as excision or permanent diversion of the ileoanal pouch. Independent predictors of pouch failure were determined by multivariate regression. RESULTS A total of 262 patients with ulcerative colitis were included. Contrast extravasation was seen in 27 patients (10.3%): 14 (51.9%) were clinically asymptomatic at the time of pouchogram. Six (22.2%) of 27 patients with extravasation developed pouch failure despite normalization of the pouchogram before ileostomy closure. Forty patients (15.3%) were found to have pouch-anal anastomotic stenosis; only 1 developed pouch failure. Pre-IPAA serum albumin and hemoglobin levels were inversely associated with contrast extravasation (serum albumin: OR = 0.42; hemoglobin: OR = 0.77; p < 0.05). Contrast extravasation was associated with delayed takedown operation (average = 67 d), increased risk (OR = 5.25; p < 0.01), and shorter time (median = 32.0 vs 72.5 mo; HR = 5.88; p < 0.05) to pouch failure, as well as increased risk of pouch-related complications (p < 0.05). LIMITATIONS The study was limited by its retrospective nature and small number of patients who developed pouch failure. CONCLUSIONS Pouchography before ileostomy takedown is useful in identifying patients with ulcerative colitis at risk for postoperative complications. Radiologic resolution of IPAA-related leak does not reliably predict healing; caution is warranted in this subgroup. See Video Abstract at http://links.lww.com/DCR/A818. |
| Databáze: | OpenAIRE |
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