Routine barium enema prior to closure of defunctioning ileostomy is not necessary pose of the study was to determine the utility of routine con- trast enema prior to ileostomy closure and its impact on patient management in patients with a low pelvic anastomosis. METHODS One hundred forty-five patients had a temporary loop ileostomy constructed to protect a low colorectal or coloa- nal anastomosis following low anterior resection for rectal cancer between 2005 and 2010 from a single institution. All patients were evaluated by physical examination, procto- scopy, and barium enema prior to ileostomy closure. Patient demographics, radiographic imaging, and clinical course were reviewed and analyzed. Routine post- operative follow-up was a clinic visit 4 to 6 weeks after sur- gery at which time patients underwent clinical evaluation including a digital rectal examination and proctoscopy by two colorectal surgeons. Patients were then seen again ap- proximately 3 months postoperatively at which time they were again evaluated by digital rectal examination and proctoscopy. After this clinic visit, each patient underwent radiographic evaluation of the distal anastomosis by con- trast enema. If the anastomosis appeared intact and patent on examination, the patient was scheduled for ileostomy closure. The procedure was performed by a radiographer under fluoroscopic guidance. A 24-Fr Foley catheter was inserted via the patient’s anus, and a sufficient amount of contrast was introduced slowly to distend and highlight the anastomosis and the proximal bowel. Postevacuation views were obtained for every patient. Contrast enema re- sults were reviewed and compared with the information gained from patient symptoms and clinical examination. Barium enema image before ileostomy closure was re- viewed for radiographic signs of stricture or fistula at the ileoanal anastomosis. The comparison was made to determine if routine contrast enema prior to stoma closure affected patient management. RESULTS thesurgery.or.kr One hundred thirty-eight patients underwent con- struction of a temporary defunctioning loop ileostomy to protect anastomosis. And 7 patients underwent con- struction of an ileostomy after anastomotic leak. One pa- tients developed barium peritonitis due to iatrogenic bow- el perforation during barium enema examination. Finally 144 patients were included in this study (Table 1). There were 83 men and 61 women with a mean age of 59.5 years (range, 28 to 87 years). Barium enema was performed and reviewed before the ileostomy closure. The median time from ileostomy creation to closure was 8 months. Five (3.5%) of the 144 patients were found to have clin- ically relevant strictures at the colorectal anastomosis on routine barium enema before ileostomy closure (Fig. 1A). The all strictures were resolved by digital rectal dilatation. Of the 144 patients evaluated in this study, 1 patient (0.7%) showed anastomotic leak on their barium enema but he had no clinical signs or symptoms suggestive of clinical anastomotic failure (Fig. 1B). The patient was re- versed without repeating the barium enema 1 month later and had an uneventful postoperative course. Overall, 141 patients (97.9%) had an uncomplicated postoperative course. Postoperative complication oc- curred in 3 patients (2.1%). These patients are summarized in Table 2. One of them showed a stenosis on barium ene- ma image and two had a normal finding. Table 1. Patients characteristics Characteristic Gender, n (%) Male Female Mean age (yr), mean ± SD Time to ileostomy closure (mo), median (range) Tumor location Upper Mid Lower Procedure Colorectal Coloanal Barium enema image Negative Leak Stenosis Value 83 (57.6) 61 (42.4) 59.5 ± 11.6 8.0 (2-23) 55 60 29 133 11 138 1 5 89