Abstract
Ultra-low anterior resection for low rectal cancer is usually done with a covering ileostomy as a safety measure to reduce the consequences of distal anastomotic failure. In many centres, distal loopogram is performed routinely, prior to the closure of the loop ileostomy, to assess the integrity of anastomosis. Distal loopogram is generally considered a safe procedure with very low complication rates, especially when water-soluble contrast is used. We report two cases of delayed bowel perforation which led to severe sepsis and generalized peritonitis after distal loopogram prior to ileostomy closure. Our cases highlight the potential dangers of distal loopogram. Therefore, the routine usage of this procedure should be scrutinized and the patient needs to be properly counselled prior to the procedure.
Highlights
Ultra-low anterior resection (ULAR) has a significant anastomotic leak rate with published rates varying from 2.8 to 25% [1]
Contrast studies like distal loopogram (DL) are routinely performed in many centres to assess the integrity of the ULAR anastomosis, before closure of the covering ileostomy
We recently encountered two cases of iatrogenic, delayed bowel perforations post-routine distal loopogram, which led to significant peritoneal contamination and sepsis, requiring emergency surgery
Summary
Ultra-low anterior resection (ULAR) has a significant anastomotic leak rate with published rates varying from 2.8 to 25% [1]. A covering ileostomy is usually performed to decrease clinical anastomotic leak and reoperation rates. Contrast studies like distal loopogram (DL) are routinely performed in many centres to assess the integrity of the ULAR anastomosis, before closure of the covering ileostomy. The value of this practice is question-. Distal loopogram is generally considered safe, with a very low complication rate, especially when water-soluble contrast (e.g. Gastrografin) is used. We recently encountered two cases of iatrogenic, delayed bowel perforations post-routine distal loopogram, which led to significant peritoneal contamination and sepsis, requiring emergency surgery
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