Routine use of gastrograffin enema prior to the reversal of a loop ileostomy

Anastomotic failure occurs in up to 10% of patients following anterior resection. Selective use of a loop ileostomy may reduce the septic consequences of anastomotic leak. The use of gastrograffin enema to confirm the anastomotic integrity prior to ileostomy closure is still controversial. Our aim was to determine the impact of the routine use of gastrograffin enema on patients' management prior to ileostomy reversal.

A review of 81 patients who underwent low anterior resection with loop ileostomy for rectal cancer over 3 years.

Gastrograffin enema was performed in 69 patients (85.2%). The mean time from operation to gastrograffin enema was 22 weeks. Four patients (5.8%) had a positive radiological leak without clinical suspicion of anastomotic problems, 2 patients (2.9%) of these subsequently had the ileostomy closed despite the positive result, 2 patients (2.9%) had a gastrograffin enema repeated which showed no leak and the patients are awaiting reversal.

The incidence of positive radiological leak in uncomplicated patients is low; such patients had their loop ileostomies closed with or without serial gastrograffin enema. Routine gastrograffin enema in the absence of a clinical suspicion of anastomotic failure would appear to be of little value.