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Colostomy on CT and fluoroscopy: What the radiologist needs to know

Published:February 20, 2019DOI:https://doi.org/10.1016/j.clinimag.2019.02.010

      Highlights

      • Types of colostomies include end, loop, double barrel and end colostomy with mucous fistula
      • Ostomy evaluation is usually performed via fluoroscopy
      • Earlostomy complications include infection, abscess, leak, ischemia, stomal retraction and obstruction.
      • Delayed ostomy complications include hernia, prolapse, colitis, stenosis, and peristomal varices.

      Abstract

      Colostomies are commonly created in conjunction with colorectal surgery performed for both malignant and benign indications. Familiarity with the different types of colostomies and their normal imaging appearance will improve radiologic detection and characterization of colostomy complications. The radiologist plays a large role in assessment of colostomy patients either via fluoroscopic technique or multidetector computed tomography (CT) in order to help identify ostomy complications or to aid the surgeon prior to colostomy reversal. In this article, we will review: (1) the types of colostomies and indications for their creation; (2) the proper radiographic technique of ostomy evaluation; and (3) the potential complications of colostomies and their imaging manifestations.

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      References

        • Land R.E.
        Colostomy enema. Description of a catheter-nipple device.
        Radiology. 1971; 100: 36
        • Pochaczevsky R.
        A colostomy device for barium enema examinations.
        Radiology. 1982; 143: 565
        • Williams J.T.
        • Scott R.L.
        A new universal colostomy tip for barium enemas of the colon.
        AJR Am J Roentgenol. 2003; 180: 1330-1331
        • Lee J.H.
        • et al.
        CT colonography in patients who have undergone sigmoid colostomy: a feasibility study.
        AJR Am J Roentgenol. 2011; 197: W653-W657
        • Ito D.
        • Teruya M.
        • Hata S.
        • Kobayashi K.
        • Kaminishi M.
        Transverse carcinoma after miles operation: a case in which preoperative evaluation was assisted by computed tomographic colonography.
        World J Surg Oncol. 2016; 14118
        • Teo J.Y.
        • Low O.W.
        • Ho K.S.
        Colonic perforation caused by direct trauma during computed tomographic colonography performed via end colostomy.
        Singapore Med J. 2011; 52: e248
        • Shabbir J.
        • Britton D.C.
        Stoma complications: a literature overview.
        Colorectal Dis. 2010; 12: 958-964
        • Bafford A.C.
        • Irani J.L.
        Management and complications of stomas.
        Surg Clin North Am. 2013; 93: 145-166
        • Cottam J.
        • et al.
        Results of a nationwide prospective audit of stoma complications within 3 weeks of surgery.
        Colorectal Dis. 2007; 9: 834-838
        • Kann B.R.
        Early stomal complications.
        Clin Colon Rectal Surg. 2008; 21: 23-30
        • Parmar K.L.
        • et al.
        A prospective audit of early stoma complications in colorectal cancer treatment throughout the Greater Manchester and Cheshire colorectal cancer network.
        Colorectal Dis. 2011; 13: 935-938
        • Landmann R.G.
        Routine care of patients with an ileostomy or colostomy and management of ostomy complications.
        UpToDate, 2017
        • Gore R.M.
        • et al.
        CT diagnosis of postoperative abdominal complications.
        Semin Ultrasound CT MR. 2004; 25: 207-221
        • Smith-Behn J.
        • Arnold M.
        • Might J.
        Use of computerized tomography of the abdominal wall in the diagnosis of partial post-operative wound dehiscence.
        Postgrad Med J. 1986; 62: 947-948
        • Zissin R.
        • Gayer G.
        Postoperative anatomic and pathologic findings at CT following colonic resection.
        Semin Ultrasound CT MR. 2004; 25: 222-238
        • Cherukuri R.
        • et al.
        Hartmann's pouch: radiographic evaluation of postoperative findings.
        AJR Am J Roentgenol. 1998; 171: 1577-1582
        • Kim J.T.
        • Kumar R.R.
        Reoperation for stoma-related complications.
        Clin Colon Rectal Surg. 2006; 19: 207-212
        • Shellito P.C.
        Complications of abdominal stoma surgery.
        Dis Colon Rectum. 1998; 41: 1562-1572
        • Harris D.A.
        • et al.
        Complications and mortality following stoma formation.
        Ann R Coll Surg Engl. 2005; 87: 427-431
        • Arumugam P.J.
        • et al.
        A prospective audit of stomas—analysis of risk factors and complications and their management.
        Colorectal Dis. 2003; 5: 49-52
        • Weinstein S.
        • et al.
        Multidetector CT of the postoperative colon: review of normal appearances and common complications.
        Radiographics. 2013; 33: 515-532
        • Frager D.
        • et al.
        Prospective evaluation of colonic obstruction with computed tomography.
        Abdom Imaging. 1998; 23: 141-146
        • Obuz F.
        • et al.
        The efficacy of helical CT in the diagnosis of small bowel obstruction.
        Eur J Radiol. 2003; 48: 299-304
        • Gazelle G.S.
        • et al.
        Efficacy of CT in distinguishing small-bowel obstruction from other causes of small-bowel dilatation.
        AJR Am J Roentgenol. 1994; 162: 43-47
        • Husain S.G.
        • Cataldo T.E.
        Late stomal complications.
        Clin Colon Rectal Surg. 2008; 21: 31-40
        • Sohn Y.J.
        • et al.
        Incidence and risk factors of parastomal hernia.
        J Korean Soc Coloproctol. 2012; 28: 241-246
        • Bruce R.
        • Javors E.L.W.
        Radiology of postoperative GI tract.
        2003
        • Cima R.R.
        Parastomal hernia.
        UpToDate, 2006
        • Jaffe T.A.
        • et al.
        MDCT of abdominal wall hernias: is there a role for Valsalva's maneuver?.
        AJR Am J Roentgenol. 2005; 184: 847-851
        • Gurmu A.
        • Gunnarsson U.
        • Strigard K.
        Imaging of parastomal hernia using three-dimensional intrastomal ultrasonography.
        Br J Surg. 2011; 98: 1026-1029
        • Janes A.
        • Weisby L.
        • Israelsson L.A.
        Parastomal hernia: clinical and radiological definitions.
        Hernia. 2011; 15: 189-192
        • Glotzer D.J.
        • Glick M.E.
        • Goldman H.
        Proctitis and colitis following diversion of the fecal stream.
        Gastroenterology. 1981; 80: 438-441
        • Whelan R.L.
        • et al.
        Diversion colitis. A prospective study.
        Surg Endosc. 1994; 8: 19-24
        • Scott R.L.
        • Pinstein M.L.
        Diversion colitis demonstrated by double-contrast barium enema.
        AJR Am J Roentgenol. 1984; 143: 767-768
        • Lafreniere R.
        • Ketcham A.S.
        Hartmann's pouch carcinoma.
        J Surg Oncol. 1985; 29: 26-27
        • Caricato M.
        • et al.
        Retrospective analysis of long-term defunctioning stoma complications after colorectal surgery.
        Colorectal Dis. 2007; 9: 559-561
        • Park J.J.
        • et al.
        Stoma complications: the Cook County Hospital experience.
        Dis Colon Rectum. 1999; 42: 1575-1580
        • Ackerman N.B.
        • Graeber G.M.
        • Fey J.
        Enterostomal varices secondary to portal hypertension: progression of disease in conservatively managed cases.
        Arch Surg. 1980; 115: 1454-1455