Title

The utility of routine pouchogram before ileostomy reversal in children and adolescents following ileal pouch anal anastomosis

Document Type

Journal Article

Publication Date

6-1-2011

Journal

Journal of Pediatric Surgery

Volume

46

Issue

6

DOI

10.1016/j.jpedsurg.2011.03.055

Keywords

Children; Ileal pouch; J-pouch; Pouchogram

Abstract

Introduction: Pouchograms are used to assess the integrity of the ileal pouch anal anastomosis (IPAA) in patients who have undergone restorative proctocolectomy. Its benefits have been questioned, and there are no data to support the routine use in children. Methods: We retrospectively reviewed the charts of 26 patients who had an IPAA and pouchogram at our institution between 2001 and 2009. Each patient also underwent an examination under anesthesia to assess the integrity of the IPAA on the day of the ileostomy closure. Results: The mean age of the patients was 13.8 (±0.7) years. The pouchogram was performed at a median of 6 weeks after the IPAA (range, 4-20 weeks). The findings were normal in 26 (89.7%) and demonstrated stricture in 2 (6.9%) and leak in 1 (3.4%). History was suggestive and physical examination was confirmatory in these 3 problematic cases. Conclusions: A contrast enema is not routinely required to evaluate the integrity of the IPAA before ileostomy reversal in pediatric patients. Complications can be detected by history and rectal examination before ileostomy closure. We recommend the use of contrast enema only in symptomatic patients where a leak is suspected, thereby limiting radiation exposure and inconvenience. © 2011 Elsevier Inc. All rights reserved.

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