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Multimodality imaging in assessment of intestinal complications pre-stomal reversal

journal contribution
posted on 2024-05-02, 01:13 authored by Mohamed A Abdelatty, Nema Aboelmagd, Mohamed Fouad Osman, Mohamed Tamer Mohamed, Shady MohamedShady Mohamed
Abstract Background Several imaging modalities are available to assess complications post intestinal stoma creation. The aim of this study was the radiological assessment of intestinal complications pre-stomal closure using routine fluoroscopic water-soluble contrast enema (WSCE), combined CT-WSCE, and MRI-enema with rectal gel administration. Additionally, we aimed to investigate the potential alterations in the surgical management plan based on imaging findings. Results This prospective cross-sectional study recruited 130 patients with stomas referred for the assessment of stoma integrity. Thirty-six patients with stoma-related intestinal complications were included. Patients with complications were subdivided into 3 groups. Group A 15 patients with intestinal stomas referred for WSCE pre-stomal closure and complementary CT-WSCE evaluation was performed. Comparison between the detection of the complications by WSCE alone and combined CT-WSCE among group A was statistically significant (p = 0.008) yet the alteration of the surgical plan based on both modalities was not statistically significant (p = 0.063). Group B 11 patients with poor general conditions were referred directly for combined CT-WSCE assessment, complications diagnosed in this group: 6 (54.5%) intestinal obstruction, 2 (18.2%) pericolic collections, 2 (18.2%) abnormal fistula and 1 (9.1%) anastomotic leak. Group C 10 patients with intestinal stomas with malignant or inflammatory conditions referred directly for MRI-enema assessment, showed complications as follows: 3 (30%) colon/rectal tumoral recurrence, 2 (20%) strictures, 2 (20%) pericolic collections and 3 (30%) abnormal intestinal fistulous communications. Comparison between complicated colorectal cancer patients (20 patients) versus other complicated patients secondary to other surgical indications (16 patients) enrolled in the study from the 3 different groups was not statistically significant (p = 0.125). Conclusions Combined CT and WSCE is superior in the detection of intestinal fistulas, peri-colic collections, tumor recurrence, and para-stomal hernias than WSCE alone and might lead to a change of management. MRI after rectal gel administration can serve as reliable substitute in some patients for the detection of intestinal complications namely fistulas and tumor recurrence.

History

Journal

Egyptian Journal of Radiology and Nuclear Medicine

Volume

54

Article number

140

Pagination

1-13

Location

London, Eng.

ISSN

0378-603X

eISSN

2090-4762

Language

eng

Publication classification

C1.1 Refereed article in a scholarly journal

Issue

1

Publisher

SpringerOpen