Sung Yeon Hong, et al. Fig. 1. (A) A64-year-old man with stricture at colorectal anastomosis after low anterior resection for rectal cancer. (B) A52-year-old man with fistula at rectal stump after low anterior resection for rectal cancer. Table 2. Patients with a postoperative anastomotic problem Diagnosis Anastomosis Barium enema Mid rectal cancer Colorectal Stenosis Low rectal cancer Colorectal Normal Mid rectal cancer Colorectal Normal CT, computed tomography. DISCUSSION The incidence of anastomotic leaks for colorectal anas- tomoses has been reported to range from approximately 3 to 12%. A loop ileostomy is constructed traditionally to re- duce the septic consequences of anastomotic failure. A ba- rium enema is done before ileostomy closure in order to evaluate the integrity of anastomosis and to confirm no evidence of any leak, stenosis or fistula. We analyzed the clinical usefulness of barium enema of the colorectal anas- tomosis prior to ileostomy closure. In this study, it has been shown that the use of barium enema before ileostomy closure has no benefit in predict- ing postoperative colorectal anastomotic complications. Only one (0.7%) of the 144 patients who had barium en- ema examination prior to ileostomy closure had a positive radiological finding of leak. This patient underwent ileos- tomy closure 1 month after examination because of non- specific finding on pelvic computed tomography (CT) and had no problem in the colorectal anastomosis after 90 Detection method Clinical/CT Clinical/CT Clinical/CT Symptoms Perianal pain Fever, perianal pain Fever, perianal pain Time to leak (mo) 6 10 4 operation. This rate was in accordance to other results in the literature. One study showed that the radiological leak rate was low where only 4 (5.9%) of the 69 patients had a positive radiological leak [8]. The other study showed no radiological leak on all patients who underwent anterior resection and defunctioning stoma formation [9]. Anastomotic stricture was the most common complica- tion, especially in patients with cancer who had radiation therapy. In this study five patients showed stricture on ra- diologic imaging. Dolinsky et al. [10] suggested that the contrast enema is a more objective and reliable test for de- tecting strictures at the ileoanal anastomosis when a fixed threshold diameter is used. da Silva et al. [11] suggested that strictures may be reliably diagnosed by a simple digi- tal rectal examination, and pouchogram does not contrib- ute in diagnosing a clinically unsuspected stricture. In our cases, this problem could be detected clinically in the pre- operative state as a result of routine pelvic examination, and managed nonoperatively by digital rectal dilatation. Therefore, it is not necessary to take a barium enema exam thesurgery.or.kr