Ileostomy closure without contrast study is safe in selected patients

Following anterior resection of the rectum it is common to defunction the anastomosis with an ileostomy. Prior to closure of this, a contrast study is usually performed to check for healing. Several patients at our institution have not undergone a contrast study prior to closure. The present study aimed to compare outcome in this group with patients who had undergone contrast radiology.

A retrospective review of patients undergoing anterior resection with an ileostomy was performed. We only included those patients who had a straight colorectal/coloanal anastomosis that could be examined clinically and had a smooth postoperative course with no evidence of pelvic sepsis.

Fifty-nine patients fulfilled the criteria for the study. Thirty-five patients had a contrast study. These showed two leaks and five strictures. The anastomosis was 0-7 cm from the anal verge in 31 patients (16 contrast studies). It was above 7 cm in 28 patients (19 contrast studies). No patient had pelvic sepsis after ileostomy reversal.

In patients with an ileostomy following anterior resection, with a clinically examinable anastomosis and a smooth postoperative course, a radiological examination of the anastomosis prior to ileostomy closure appears unnecessary.