Fluoroscopy Contrast Enema Fluoroscopic contrast enemas performed for the diagnosis of perforation or leak, rectovaginal or rectovesicular fistula, pouchitis, or proctitis can be performed with water-soluble contrast or barium. In general, water-soluble contrast is preferred if a leak or perforation are suspected in order to avoid barium spillage into the peritoneal cavity or extraperitoneal pelvis. Using barium may also interfere with a subsequent CT scan because of the streak artifact that it causes on CT. Fluoroscopic water-soluble contrast enema is routinely used to evaluate clinically suspected leaks, anastomotic stenoses, fistulas, and sinus tracts. It may be complementary to CT or performed in conjunction with CT. In the study by Tang et al [62], water-soluble contrast enema was performed in 33 of the 66 patients evaluated for pouch disorders and compared with a composite clinical diagnosis. The sensitivity and specificity for the diagnosis of small-bowel and inlet strictures was 80% and 95.7%, and pouch outlet strictures was 0% and 93.5%, respectively. They also found the sensitivity and specificity for the diagnosis of fistula was 33.3% and 96.3%, sinus tract 50% and 100%, pouch leak 50% and 96.8%, respectively [62]. In some institutions, routine water-soluble contrast enema is performed prior to ileostomy takedown. In a study of 42 patients who underwent total proctocolectomy with IPAA, Dolinsky et al [63] showed that 14% of patients had clinically significant occult strictures detected by water- soluble contrast enema prior to ileostomy takedown. On the other hand, others report that routine use of fluoroscopic water-soluble contrast enema in patients with low pelvic anastomoses (ultralow colorectal, coloanal, and IPAA) does not impact ileostomy takedown compared with digital rectal examination and colonoscopy or sigmoidoscopy.
Anorectal Disease. Fluoroscopy Contrast Enema Fluoroscopic contrast enemas performed for the diagnosis of perforation or leak, rectovaginal or rectovesicular fistula, pouchitis, or proctitis can be performed with water-soluble contrast or barium. In general, water-soluble contrast is preferred if a leak or perforation are suspected in order to avoid barium spillage into the peritoneal cavity or extraperitoneal pelvis. Using barium may also interfere with a subsequent CT scan because of the streak artifact that it causes on CT. Fluoroscopic water-soluble contrast enema is routinely used to evaluate clinically suspected leaks, anastomotic stenoses, fistulas, and sinus tracts. It may be complementary to CT or performed in conjunction with CT. In the study by Tang et al [62], water-soluble contrast enema was performed in 33 of the 66 patients evaluated for pouch disorders and compared with a composite clinical diagnosis. The sensitivity and specificity for the diagnosis of small-bowel and inlet strictures was 80% and 95.7%, and pouch outlet strictures was 0% and 93.5%, respectively. They also found the sensitivity and specificity for the diagnosis of fistula was 33.3% and 96.3%, sinus tract 50% and 100%, pouch leak 50% and 96.8%, respectively [62]. In some institutions, routine water-soluble contrast enema is performed prior to ileostomy takedown. In a study of 42 patients who underwent total proctocolectomy with IPAA, Dolinsky et al [63] showed that 14% of patients had clinically significant occult strictures detected by water- soluble contrast enema prior to ileostomy takedown. On the other hand, others report that routine use of fluoroscopic water-soluble contrast enema in patients with low pelvic anastomoses (ultralow colorectal, coloanal, and IPAA) does not impact ileostomy takedown compared with digital rectal examination and colonoscopy or sigmoidoscopy.