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Delayed Bowel Perforation after Routine Distal Loopogram Prior to Ileostomy Closure.

Keat Seong Poh1, Siew Yep Hoh1, Rezal Aziz1

  • 1Department of Surgery, University Malaya, Kuala Lumpur, Malaysia.

Open Medicine (Warsaw, Poland)
|April 16, 2020
PubMed
Summary

Routine distal loopogram before ileostomy closure for rectal cancer may pose risks. Two cases of delayed bowel perforation and sepsis after this procedure highlight the need for careful consideration and patient counseling.

Keywords:
Anastomosis leakBowel perforationDistal loopogramIleostomyUltralow anterior resection

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Area of Science:

  • Colorectal Surgery
  • Surgical Safety
  • Gastrointestinal Radiology

Background:

  • Ultra-low anterior resection for rectal cancer often involves a covering ileostomy to prevent anastomotic leaks.
  • Distal loopogram is a common procedure performed before ileostomy closure to check anastomosis integrity.

Purpose of the Study:

  • To report two cases of severe complications following distal loopogram.
  • To question the routine use of distal loopogram in ileostomy closure.

Main Methods:

  • Case report of two patients who developed delayed bowel perforation after distal loopogram.
  • Review of the potential risks associated with distal loopogram.

Main Results:

  • Two patients experienced delayed bowel perforation, leading to severe sepsis and generalized peritonitis post-distal loopogram.
  • These complications occurred despite the generally perceived safety of the procedure, especially with water-soluble contrast.

Conclusions:

  • Distal loopogram, despite its common use, carries potential dangers of delayed bowel perforation.
  • Routine distal loopogram should be scrutinized, and patients require thorough counseling regarding the procedure's risks.