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Antegrade Ileography for Evaluating a Distal Anastomotic Stricture After Loop Ileostomy

Jakob C. L. Schutz1, Marc S. Levine1, Edward Y. Woo2 and John L. Rombeau2

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 19104.



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Fig. 1A. 65-year-old man with high-grade stricture at colorectal anastomosis for rectal carcinoma in whom antegrade ileography was performed to assess length of stricture and guide patient management. Frontal spot image from water-soluble contrast enema shows lumen-obliterating stricture with complete retrograde obstruction at anastomotic staple line (arrows).

 


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Fig. 1B. 65-year-old man with high-grade stricture at colorectal anastomosis for rectal carcinoma in whom antegrade ileography was performed to assess length of stricture and guide patient management. Frontal spot image from antegrade ileography (by injecting barium via catheter in efferent limb of loop ileostomy through ileocecal valve into colon) also shows complete antegrade obstruction at anastomotic staple line (arrows). A and B indicate presence of extremely short stricture at colorectal anastomosis.

 


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Fig. 1C. 65-year-old man with high-grade stricture at colorectal anastomosis for rectal carcinoma in whom antegrade ileography was performed to assess length of stricture and guide patient management. Frontal spot image from repeat water-soluble contrast enema 1 day after dilatation procedure shows patent colorectal anastomosis, with narrowing and irregularity of anastomotic region (arrow), most likely secondary to postprocedural edema and inflammation.

 

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