Pouchogram Prior to Ileostomy Reversal after Ileal Pouch-Anal Anastomosis in Pediatric Patients: Is it Useful in the Setting of Routine EUA?

Michael D. Traynor, Nicholas P. McKenna, Elizabeth B. Habermann, Ryan M. Antiel, Christopher R. Moir, Denise B. Klinkner, Michael B. Ishitani, D. Dean Potter

Research output: Contribution to journalArticle

Abstract

Purpose: To determine if there is a role for routine pouchogram before ileostomy reversal after IPAA in pediatric patients. Methods: The medical records of pediatric patients who underwent pouchogram between 2007 and 2017 prior to ileostomy reversal after IPAA at two affiliated hospitals were reviewed for concordance between exam under anesthesia (EUA) and pouchogram findings, management of abnormal pouchogram findings, and short and long-term outcomes after ileostomy reversal. Clinical notes were used to find patient-reported symptoms at the time of pouchogram. Results: Sixty patients (57% female) underwent pouchogram before planned ileostomy reversal. The median time from IPAA formation to pouchogram was 60.5 days (IQR: 46–77) and median follow-up was 4 years (IQR: 1–6). Fifty-seven patients (95%) were asymptomatic prior to reversal. Of the 40 asymptomatic patients with a normal EUA, pouchogram detected one stricture (3%), but reversal proceeded as planned. In the 16 patients with strictures on EUA, pouchogram only detected six (40%). One of 50 (2%) asymptomatic patients with normal pouchogram had anastomotic dehiscence found on EUA. Despite normal pouchogram and EUA, four asymptomatic patients required subsequent diversion for pouch-related complications between 13 and 60 months after ileostomy reversal. Three patients had pelvic pain prior to pouchogram; associated symptoms included perineal pain (n = 1) hematochezia (n = 1), and tenesmus (n = 1). EUA and pouchogram were concordant in two patients (n = 1 anastomotic complication, n = 1 pouch septum) and ileostomy reversal was delayed. In the remaining symptomatic patient, pouchogram detected an anastomotic leak where EUA detected only a stricture, and this prompted a delay in reversal. Long term, none of these patients required diversion or excision of their pouch. Conclusion: Routine pouchogram in asymptomatic pediatric patients does not change management and can be omitted, thereby sparing patients discomfort and unnecessary radiation exposure. Pouchogram may have diagnostic value in symptomatic patients. Level of Evidence: III. Type of Study: Study of Diagnostic Test.

Original languageEnglish (US)
JournalJournal of pediatric surgery
DOIs
StateAccepted/In press - Jan 1 2019

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Colonic Pouches
Ileostomy
Anesthesia
Pediatrics
Pathologic Constriction
Anastomotic Leak
Pelvic Pain
Gastrointestinal Hemorrhage

Keywords

  • Contrast study
  • Exam under anesthesia (EUA)
  • Ileal pouch-anal anastomosis (IPAA)
  • Ileostomy reversal
  • Pouchogram

ASJC Scopus subject areas

  • Surgery
  • Pediatrics, Perinatology, and Child Health

Cite this

Pouchogram Prior to Ileostomy Reversal after Ileal Pouch-Anal Anastomosis in Pediatric Patients : Is it Useful in the Setting of Routine EUA? / Traynor, Michael D.; McKenna, Nicholas P.; Habermann, Elizabeth B.; Antiel, Ryan M.; Moir, Christopher R.; Klinkner, Denise B.; Ishitani, Michael B.; Potter, D. Dean.

In: Journal of pediatric surgery, 01.01.2019.

Research output: Contribution to journalArticle

Traynor, Michael D. ; McKenna, Nicholas P. ; Habermann, Elizabeth B. ; Antiel, Ryan M. ; Moir, Christopher R. ; Klinkner, Denise B. ; Ishitani, Michael B. ; Potter, D. Dean. / Pouchogram Prior to Ileostomy Reversal after Ileal Pouch-Anal Anastomosis in Pediatric Patients : Is it Useful in the Setting of Routine EUA?. In: Journal of pediatric surgery. 2019.
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abstract = "Purpose: To determine if there is a role for routine pouchogram before ileostomy reversal after IPAA in pediatric patients. Methods: The medical records of pediatric patients who underwent pouchogram between 2007 and 2017 prior to ileostomy reversal after IPAA at two affiliated hospitals were reviewed for concordance between exam under anesthesia (EUA) and pouchogram findings, management of abnormal pouchogram findings, and short and long-term outcomes after ileostomy reversal. Clinical notes were used to find patient-reported symptoms at the time of pouchogram. Results: Sixty patients (57{\%} female) underwent pouchogram before planned ileostomy reversal. The median time from IPAA formation to pouchogram was 60.5 days (IQR: 46–77) and median follow-up was 4 years (IQR: 1–6). Fifty-seven patients (95{\%}) were asymptomatic prior to reversal. Of the 40 asymptomatic patients with a normal EUA, pouchogram detected one stricture (3{\%}), but reversal proceeded as planned. In the 16 patients with strictures on EUA, pouchogram only detected six (40{\%}). One of 50 (2{\%}) asymptomatic patients with normal pouchogram had anastomotic dehiscence found on EUA. Despite normal pouchogram and EUA, four asymptomatic patients required subsequent diversion for pouch-related complications between 13 and 60 months after ileostomy reversal. Three patients had pelvic pain prior to pouchogram; associated symptoms included perineal pain (n = 1) hematochezia (n = 1), and tenesmus (n = 1). EUA and pouchogram were concordant in two patients (n = 1 anastomotic complication, n = 1 pouch septum) and ileostomy reversal was delayed. In the remaining symptomatic patient, pouchogram detected an anastomotic leak where EUA detected only a stricture, and this prompted a delay in reversal. Long term, none of these patients required diversion or excision of their pouch. Conclusion: Routine pouchogram in asymptomatic pediatric patients does not change management and can be omitted, thereby sparing patients discomfort and unnecessary radiation exposure. Pouchogram may have diagnostic value in symptomatic patients. Level of Evidence: III. Type of Study: Study of Diagnostic Test.",
keywords = "Contrast study, Exam under anesthesia (EUA), Ileal pouch-anal anastomosis (IPAA), Ileostomy reversal, Pouchogram",
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T1 - Pouchogram Prior to Ileostomy Reversal after Ileal Pouch-Anal Anastomosis in Pediatric Patients

T2 - Is it Useful in the Setting of Routine EUA?

AU - Traynor, Michael D.

AU - McKenna, Nicholas P.

AU - Habermann, Elizabeth B.

AU - Antiel, Ryan M.

AU - Moir, Christopher R.

AU - Klinkner, Denise B.

AU - Ishitani, Michael B.

AU - Potter, D. Dean

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Purpose: To determine if there is a role for routine pouchogram before ileostomy reversal after IPAA in pediatric patients. Methods: The medical records of pediatric patients who underwent pouchogram between 2007 and 2017 prior to ileostomy reversal after IPAA at two affiliated hospitals were reviewed for concordance between exam under anesthesia (EUA) and pouchogram findings, management of abnormal pouchogram findings, and short and long-term outcomes after ileostomy reversal. Clinical notes were used to find patient-reported symptoms at the time of pouchogram. Results: Sixty patients (57% female) underwent pouchogram before planned ileostomy reversal. The median time from IPAA formation to pouchogram was 60.5 days (IQR: 46–77) and median follow-up was 4 years (IQR: 1–6). Fifty-seven patients (95%) were asymptomatic prior to reversal. Of the 40 asymptomatic patients with a normal EUA, pouchogram detected one stricture (3%), but reversal proceeded as planned. In the 16 patients with strictures on EUA, pouchogram only detected six (40%). One of 50 (2%) asymptomatic patients with normal pouchogram had anastomotic dehiscence found on EUA. Despite normal pouchogram and EUA, four asymptomatic patients required subsequent diversion for pouch-related complications between 13 and 60 months after ileostomy reversal. Three patients had pelvic pain prior to pouchogram; associated symptoms included perineal pain (n = 1) hematochezia (n = 1), and tenesmus (n = 1). EUA and pouchogram were concordant in two patients (n = 1 anastomotic complication, n = 1 pouch septum) and ileostomy reversal was delayed. In the remaining symptomatic patient, pouchogram detected an anastomotic leak where EUA detected only a stricture, and this prompted a delay in reversal. Long term, none of these patients required diversion or excision of their pouch. Conclusion: Routine pouchogram in asymptomatic pediatric patients does not change management and can be omitted, thereby sparing patients discomfort and unnecessary radiation exposure. Pouchogram may have diagnostic value in symptomatic patients. Level of Evidence: III. Type of Study: Study of Diagnostic Test.

AB - Purpose: To determine if there is a role for routine pouchogram before ileostomy reversal after IPAA in pediatric patients. Methods: The medical records of pediatric patients who underwent pouchogram between 2007 and 2017 prior to ileostomy reversal after IPAA at two affiliated hospitals were reviewed for concordance between exam under anesthesia (EUA) and pouchogram findings, management of abnormal pouchogram findings, and short and long-term outcomes after ileostomy reversal. Clinical notes were used to find patient-reported symptoms at the time of pouchogram. Results: Sixty patients (57% female) underwent pouchogram before planned ileostomy reversal. The median time from IPAA formation to pouchogram was 60.5 days (IQR: 46–77) and median follow-up was 4 years (IQR: 1–6). Fifty-seven patients (95%) were asymptomatic prior to reversal. Of the 40 asymptomatic patients with a normal EUA, pouchogram detected one stricture (3%), but reversal proceeded as planned. In the 16 patients with strictures on EUA, pouchogram only detected six (40%). One of 50 (2%) asymptomatic patients with normal pouchogram had anastomotic dehiscence found on EUA. Despite normal pouchogram and EUA, four asymptomatic patients required subsequent diversion for pouch-related complications between 13 and 60 months after ileostomy reversal. Three patients had pelvic pain prior to pouchogram; associated symptoms included perineal pain (n = 1) hematochezia (n = 1), and tenesmus (n = 1). EUA and pouchogram were concordant in two patients (n = 1 anastomotic complication, n = 1 pouch septum) and ileostomy reversal was delayed. In the remaining symptomatic patient, pouchogram detected an anastomotic leak where EUA detected only a stricture, and this prompted a delay in reversal. Long term, none of these patients required diversion or excision of their pouch. Conclusion: Routine pouchogram in asymptomatic pediatric patients does not change management and can be omitted, thereby sparing patients discomfort and unnecessary radiation exposure. Pouchogram may have diagnostic value in symptomatic patients. Level of Evidence: III. Type of Study: Study of Diagnostic Test.

KW - Contrast study

KW - Exam under anesthesia (EUA)

KW - Ileal pouch-anal anastomosis (IPAA)

KW - Ileostomy reversal

KW - Pouchogram

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