Poh Keat Seong, Hoh Siew Yep, Aziz Rezal, Chong Shun Siang, Roslani April Camilla
Department of Surgery, University Malaya, Kuala Lumpur, Malaysia.
Open Med (Wars). 2020 Apr 4;15:261-265. doi: 10.1515/med-2020-0037. eCollection 2020.
Ultra-low anterior resection for low rectal cancer is usually done with a covering ileostomy as a safety measure to reduce the consequences of distal anastomotic failure. In many centres, distal loopogram is performed routinely, prior to the closure of the loop ileostomy, to assess the integrity of anastomosis. Distal loopogram is generally considered a safe procedure with very low complication rates, especially when water-soluble contrast is used. We report two cases of delayed bowel perforation which led to severe sepsis and generalized peritonitis after distal loopogram prior to ileostomy closure. Our cases highlight the potential dangers of distal loopogram. Therefore, the routine usage of this procedure should be scrutinized and the patient needs to be properly counselled prior to the procedure.
低位直肠癌的超低位前切除术通常会做一个覆盖性回肠造口术作为安全措施，以降低远端吻合失败的后果。在许多中心，在关闭袢式回肠造口术前常规进行远端肠造影，以评估吻合口的完整性。远端肠造影通常被认为是一种安全的操作，并发症发生率很低，尤其是使用水溶性造影剂时。我们报告了两例在回肠造口术关闭前进行远端肠造影后发生延迟性肠穿孔，导致严重脓毒症和弥漫性腹膜炎的病例。我们的病例突出了远端肠造影的潜在危险。因此，应仔细审查该操作的常规使用情况，并且在操作前需要对患者进行适当的咨询。
