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Accuracy of Retrograde Ileostomy Radiographic Examination for Detecting Small-Bowel Abnormalities

¹ Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce St., Philadelphia, PA 19104.
² Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA.

OBJECTIVE. The purpose of this study was to assess the accuracy of retrograde ileostomy radiographic examination for detecting small-bowel abnormalities in patients with ileostomies.

MATERIALS AND METHODS. Our database contained the records of 35 patients who had undergone retrograde ileostomy examinations from 1999–2005 and fulfilled our inclusion criteria. The images from the examinations were reviewed to determine the frequency and nature of small-bowel abnormalities, whether lateral views were obtained, and whether the catheter tip was withdrawn to the stoma. The accuracy of these examinations was determined by correlating clinical, radiographic, and surgical findings.

RESULTS. Twenty-eight (80%) of the patients had small-bowel abnormalities: adhesions in 14 (40%), adynamic small-bowel ileus in four (11%), strictures in two (6%), Crohn's disease in two (6%), focal perforation in two (6%), fistulas (one enterocutaneous and one enterovaginal) in two (6%), metastasis in one (3%), and parastomal hernia in one (3%) of the patients. The other seven (20%) patients had normal findings. Abnormalities were detected on lateral but not frontal or oblique views in six (75%) of eight patients with distal ileal disease and in three (43%) of seven patients for whom views were obtained only after withdrawal of the catheter to the stoma. Retrograde ileostomy examination had a sensitivity of 96%, specificity of 86%, positive predictive value of 96%, and negative predictive value of 86%.

CONCLUSION. Our experience suggested that retrograde ileostomy examination is an accurate technique for detecting symptomatic small-bowel abnormalities in patients with ileostomies, particularly in the distal-most portion of the ileum abutting the ileostomy stoma.

Keywords: barium study • fluoroscopy • retrograde ileostomy • small bowel • small-bowel abnormality

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