Hartmann's pouch: radiographic evaluation of postoperative findings

The purpose of this study was to determine the usefulness of contrast-enhanced radiography of the Hartmann's pouch for evaluating postoperative abnormalities.

We performed a retrospective study of 84 patients with a Hartmann's pouch who underwent contrast-enhanced radiography of the pouch during a recent 7-year period. Sixty-four patients underwent single-contrast barium studies of the pouch, 17 underwent studies with a water-soluble contrast medium, and three underwent both types of studies. The radiographic studies were reviewed to determine the types and frequency of abnormalities involving the pouch. Medical records were also reviewed to determine clinical presentation and course.

Abnormalities of the Hartmann's pouch were detected on contrast-enhanced radiography in 16 (19%) of the 84 patients. Of the 70 patients who underwent routine contrast-enhanced radiography of the pouch, 11 (16%) had abnormalities, including diversion colitis in three, leaks in two, adhesions in two, recurrent carcinoma in two, ulcerative colitis involving the pouch in one, and a stricture in one. In both patients with clinically silent leaks, the contrast-enhanced radiography was performed 3 months or more after creation of the pouch. Of the remaining 14 patients who underwent contrast-enhanced radiography because of suspected complications involving the pouch, five (36%) had abnormalities revealed, including leaks in two, fistulas in two, and recurrent carcinoma in one.

Contrast-enhanced radiography of the Hartmann's pouch revealed abnormalities of the pouch in 19% of patients, including leaks or fistulas, diversion colitis, adhesions, strictures, and recurrent tumor. Because two patients had clinically silent leaks that were detected during the late postoperative period, it may be prudent to perform these studies with a water-soluble contrast medium to avoid the problems associated with extravasation of barium into the extra- or intraperitoneal spaces.