Ju Hee Lee MD, Presenter: Nothing to Disclose

Seong Ho Park MD, Abstract Co-Author: Research Consultant, INFINITT Healthcare Co, Ltd

Seung Soo Lee MD, Abstract Co-Author: Nothing to Disclose

Ah Young Kim MD, Abstract Co-Author: Nothing to Disclose

Hyun Kwon Ha MD, Abstract Co-Author: Nothing to Disclose

A recent large study showed the effectiveness of CT colonography (CTC) for simultaneous colonic and extracolonic surveillance after colorectal cancer surgery. This study was to assess the feasibility of CTC via colostomy after abdominoperineal resection for rectal cancer, which has not been reported.

Eighteen patients (7 men 11 women; mean age±SD, 57.2 years±14.5) who had undergone abdominoperineal resection were included. Colon cleansing and fecal tagging was performed with Mg citrate and barium. A conventional small rectal catheter with a retention balloon (Bracco, Italy) was introduced through sigmoid colostomy after digital examination. The balloon was advanced several centimeters past the ostium before expansion (15-25 mL) so that there was a several-cm-thick tissue trapped between the distended balloon and the skin as the balloon was pooled back, which acted as a mechanism that prevented balloon expulsion during colon insufflation. Colon insufflation was performed using CO2, maintaining the intracolonic pressure generally below 25 mmHg throughout the examination. Right decubitus and contrast-enhanced supine scans were obtained. Balloon expulsion, air or fluid leak, degree of colonic distention (grade 1 [worst] to 4 [best]), mucosal coverage, and complications were evaluated.

Colon insufflation progressed uneventfully in all but one patient who had minor air and fluid leak. The mean amount of CO2 used±SD was 2.64 L±0.64 (range, 1.5-4.4 L). The mean distention grade±SD of each colon segment was 2.7±1.1 (sigmoid), 3.4±0.6 (descending), 3.6±0.5 (transverse), 3.6±0.5 (ascending), and 3.7±0.5 (cecum) for right-decubitus position and 2.7±1.2, 3.1±0.7, 3.7±0.5, 3.7±0.5, and 3.8±0.4, respectively, for supine position. Complete or partial collapse of the sigmoid colon occurred in both positions in 4 patients (22.2%) and in one position in 6 patients (33.3%). Areas submerged under fecal matter in both positions existed in one patient (5.6%) but could be evaluated due to fecal tagging. No notable complications occurred.

CTC via colostomy using a conventional balloon catheter is feasible except for the relatively high rate of inadequate distention of the sigmoid colon.

CTC using a balloon catheter is a feasible but limited option for colonic examination of patients with colostomy. A more robust application to practice is expected with a modified catheter design.

Lee, J, Park, S, Lee, S, Kim, A, Ha, H, CT Colonography for Patients with Colostomy: A Feasibility Study.  Radiological Society of North America 2010 Scientific Assembly and Annual Meeting, November 28 - December 3, 2010 ,Chicago IL. http://archive.rsna.org/2010/9002954.html