276 Chapter 13 In the overall cohort 1% (N=3/224) of the patients had to undergo redo-surgery following stoma reversal due to a missed stricture. These were two patients treated for NEC and the previously described patient treated for a duodenal atresia with two separate strictures. In both NEC patients, the enema prior to reversal showed a stenosis which was not identified during reversal. Obstructive symptoms necessitated a repeated enema which again was suggestive of a stricture at the same sight. During redo-surgery both strictures were identified and treated. The patients with strictures that were excluded from the analysis of the diagnostic accuracy of the enema and the patients with strictures that were missed at reversal but found during redo-surgery are discussed briefly in this article, a more extensive description of these patients can be found in Appendix 1. Usage rate and outcome of the contrast enema Contrast enemas were performed in 68% (N=151/224) of the patients prior to stoma reversal, in a median of 22 days (IQR: 8 – 33) before stoma reversal. The usage rate of the contrast enema was 70% (128/184) in patients treated with a small bowel stoma and 58% (N=23/40) in patients treated with a colostomy. None of the enemas were complicated by an intestinal perforation or an allergic reaction to the contrast. Of the contrast enemas, 36% (N=54/151) were preformed via the antegrade route, 53% (N=80/151) retrograde, 5% (N=8/151) both antegrade and retrograde and in 6% (N=9/151) it was unclear. 88% (N=21/24) of the gold standard, surgically proven, strictures were identified prior to surgery via the contrast enema. The other three strictures, were excluded from the analysis of the diagnostic accuracy of the contrast enema and have been described previously. Table 2 shows the diagnostic accuracy of the contrast enema in the overall cohort. The contrast enema studies were suggestive of a stricture in 16% (N=24/151) of the studies. Three of the enemas suggestive of a stricture were false positive. These patients will be discussed later. Taking these figures into account the contrast enema in the overall cohort shows a sensitivity of 100%, specificity of 98%, a positive predictive value of 88% and a negative predictive value of 100% whilst the AUC was 0.98 (95%-CI: 0.97 – 1.00). Of the patients with a positive contrast enema, 92% (N=22/24) were treated for NEC whilst the other two patients were treated for an intestinal atresia and Hirschsprung disease. An enema suggestive of a stricture was seen in 17% (N=22/128) of the studies in patients treated with a small bowel stoma. Of the enemas in patients treated with a colostomy this was 9% (N=2/23). Both were patients treated for NEC and both strictures were found and resected during stoma reversal.
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