283 Routinecontrastenemapriortostomareversalseemsonlyrequiredfollowingtreatmentfornecrotizingenterocolitis:Anevaluationofthediagnosticaccuracyofthecontrastenema Chapter 13 Appendix 1 – Extensive description of notable patients Strictures not included in the diagnostic accuracy of contrast enema Three strictures could not be included in the analysis of the diagnostic accuracy of the contrast enema. Reasons for exclusion of these strictures were no enema performed prior to stoma reversal, an inconclusive enema and blockage of contrast by a primary stricture which resulted in a missed second, more distal, stricture during redo-surgery. The first excluded stricture was found in a patient who was treated for extensive NEC by removal of almost all small bowel and formation of a high jejunostomy did not receive a contrast enema prior to reversal but a stricture was observed during stoma reversal. In the patient’s status, no reason was noted for not for not performing a contrast enema before stoma reversal. During stoma reversal a stricture was observed in the transverse colon at the splenic flexure. no signs of intestinal obstruction were reported during follow-up. In the second excluded patient, who was treated for necrotizing enterocolitis, the mucous fistula was occluded for which reason a retrograde, rectal enema was performed. In this enema only the sigmoid and rectum could be visualized due to an opacification yet the radiologist did not conclude there was a stricture. Therefore, this enema was deemed inconclusive. During stoma reversal the tract from the mucous fistula to the sigmoid was found to be an atresia which was removed. During follow-up no obstructive symptoms occurred. The third excluded stricture was found in a patient treated with a primary anastomosis for a duodenal atresia. A postoperative volvulus with intestinal ischemia, resulted in stoma formation. Before stoma reversal a contrast enema was made showing a stricture causing a full-stop in the proximal ileum. This stricture, which was found and resected during stoma reversal was included in the analysis of the enema’s diagnostic accuracy. However, within 42 days obstructive symptoms led to a new, retrograde, contrast enema which showed a pinpoint stricture more distal in the ileum which was also found and treated during redo-surgery. Due to the full-stop this stricture could not have been visualized on the first enema. For this reason the second stricture was excluded from the analysis. Strictures not identified during stoma reversal but during redo-surgery 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. The two patients treated for NEC both received a contrast enema before stoma reversal which showed an evident stricture in the transition zone sigmoid to descending
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