273 Routinecontrastenemapriortostomareversalseemsonlyrequiredfollowingtreatmentfornecrotizingenterocolitis:Anevaluationofthediagnosticaccuracyofthecontrastenema Chapter 13 Introduction In young children (age ≤3 years), a small bowel stoma or colostomy might be necessary in the treatment of congenital intestinal diseases or abdominal sepsis(1, 2). Such diseases include necrotizing enterocolitis (NEC), intestinal atresia, Hirschsprung disease, gastroschisis, meconium ileus or peritonitis and focal intestinal perforation. These stomas come with an increased risk of morbidity, considering both stoma creation and reversal, major stoma related morbidity (Clavien-Dindo grade ≥III) occurs in 39% of the children(3). Before surgical reversal of the stoma some surgeons ask for a contrast enema, either antegrade via the mucous fistula or retrograde via the anus, of the intestinal tract distal of the stoma in order to detect intestinal strictures. Intestinal strictures can occur due to unrecognized and untreated atresias or result after ischemic or inflammatory intestinal injury which for instance can occur in patients who experienced NEC(4). Post-NEC strictures are a common cause of strictures in these patients reported in 20-30% of the patients following surgical treatment(5-8). If these strictures are not found and treated during stoma reversal, these can result in intestinal obstruction, passage problems and redo-surgery. Previously the diagnostic yield of the contrast enema has been doubted specifically in small bowel stomas(9). This study included only four patients with a stricture and excluded colostomies. Therefore, a larger, more inclusive cohort is needed to determine if the contrast enema is useful, and if so in which group of patients. This study aims to evaluate the diagnostic accuracy of a contrast enema in identifying intestinal strictures distal of the stoma in young children (< 3 years of age) prior to stoma reversal. Methods Patients and management All consecutive young children (≤3 years of age) with an intestinal stoma (jejunostomy, ileostomy or colostomy) created between 1998 and 2018 at our tertiary university medical center were retrospectively identified from a surgical administrative database. Patients treated for anorectal malformations were excluded because the indication for a contrast enema in these patients is fistula identification rather than identifying strictures (10). Moreover, patients that died before stoma reversal were excluded. The medical ethical committee of the Academic Medical Center in Amsterdam reviewed and approved the study protocol (reference: W18_233#18.278). Patients and parents received an opt-out letter for consent.
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