Endosonographic detection of rectum anastomoses.

Following preliminary studies on 15 pig-bowel EEA anastomoses, anastomoses in 20 patients were consecutively examined between the 12th and 14th days after anterior rectum or sigmoid resection. Resections were performed on 16 patients for a malignant tumour and on 4 individuals for a benign lesion. The examination programme included detailed clinical examination of the patient, digital palpation, rectoscopy and endorectal sonography, as well as radiographic examination of the large bowel using aqueous contrast medium 1 day later. All rectoscopic and X-ray findings of anastomotic insufficiency were confirmed by means of endosonography. The sensitivity of the latter technique in verifying the radiographic detection of an insufficiency was 1 and its specificity was 0.82. Endorectal sonographic detection of an anastomotic insufficiency was successful in six cases, and suspected insufficiency was noted on three occasions. Radiographic detection of insufficiency was confirmed in three patients; radiographic results suggested an insufficiency in two cases. On one occasion, a suture insufficiency was confirmed by an immediate operation carried out without a radiographic examination. The present study shows that accurate detection of a suture insufficiency after deep resection is possible with the aid of endorectal sonography.