Routine barium enema prior to closure of defunctioning ileostomy is not necessary for finding out the anastomotic stricture after low anterior was reported. resection. In our study, 3 patients developed colorectal anasto- motic leak or abscess after operation. One of them showed a stenosis on barium enema image and two had a normal finding. The fact suggests that routine barium enema in the absence of a clinical suspicion of anastomotic failure would appear to be of little value. The patients were all male and presented with low or mid rectal cancer. The se- lective use of pouchogram at the time of suspicion for com- plications has been reported in two previous studies [12,13]. They showed pouchogram to be nonspecific and recommened CT scan to find a complication. In current study, it was difficult to predict who will develop post- operative anastomotic problem after ileostomy closure. Furthermore, one patient had peritonitis due to perfo- ration during barium enema examination. Barium peritonitis is reported to be related to a high morbidity and mortality [14], although currently mortality for adults seems to de- crease mainly because of advances in medical care [15]. In case of an underlying septic lesion, excessive air in- sufflation during the procedure may aggravate the in- fection leading to haematogenous infection. In this study, seven patients underwent ileostomy after anastomotic leak. These patients didn’t show abnormal finding on preoperative barium enema and also didn’t de- velop postoperative complication. This fact is contra- dictory to the previous study suggesting that preoperative barium enema should be considered in patients with an ileostomy constructed after anastomotic leakage [16]. In conclusion, routine contrast enema evaluation of low pelvic anastomoses before loop ileostomy closure did not provide any additional information for postoperative complication. And wheather an ileostomy is constructed during the first operation or after anastomotic leak was not related to the postoperative anastomotic problem. More study is necessary to find out the risk factor for the post- operative anastomotic complication. CONFLICTS OF INTEREST No potential conflict of interest relevant to this article thesurgery.or.kr REFERENCES 1. MacFarlane JK, Ryall RD, Heald RJ. Mesorectal excision for rectal cancer. Lancet 1993;341:457-60. 2. Williams N, Seow-Choen F. Physiological and functional outcome following ultra-low anterior resection with colon pouch-anal anastomosis. Br J Surg 1998;85:1029-35. 3. Karanjia ND, Corder AP, Bearn P, Heald RJ. Leakage from stapled low anastomosis after total mesorectal excision for carcinoma of the rectum. Br J Surg 1994;81:1224-6. 4. Arbman G, Nilsson E, Hallbook O, Sjodahl R. Local re- currence following total mesorectal excision for rectal cancer. Br J Surg 1996;83:375-9. 5. Horgan AF, Finlay IG. Preoperative staging of rectal cancer allows selection of patients for preoperative radiotherapy. Br J Surg 2000;87:575-9. 6. Wheeler JM, Gilbert JM. Controlled intraoperative water testing of left-sided colorectal anastomoses: are ileos- tomies avoidable? Ann R Coll Surg Engl 1999;81:105-8. 7. Tan WS, Tang CL, Shi L, Eu KW. Meta-analysis of de- functioning stomas in low anterior resection for rectal cancer. Br J Surg 2009;96:462-72. 8. Khair G, Alhamarneh O, Avery J, Cast J, Gunn J, Monson JR, et al. Routine use of gastrograffin enema prior to the re- versal of a loop ileostomy. Dig Surg 2007;24:338-41. 9. MacLeod I, Watson AJ, Hampton J, Hussey JK, O'Kelly TJ. Colonic pouchography is not routinely required prior to stoma closure. Colorectal Dis 2004;6:162-4. 10. Dolinsky D, Levine MS, Rubesin SE, Laufer I, Rombeau JL. Utility of contrast enema for detecting anastomotic stric- tures after total proctocolectomy and ileal pouch-anal anastomosis. AJR Am J Roentgenol 2007;189:25-9. 11. da Silva GM, Wexner SD, Gurland B, Gervaz P, Moon SD, Efron J, et al. Is routine pouchogram prior to ileostomy clo- sure in colonic J-pouch really necessary? Colorectal Dis 2004;6:117-20. 12. Brown JJ, Balfe DM, Heiken JP, Becker JM, Soper NJ. Ileal J pouch: radiologic evaluation in patients with and without postoperative infectious complications. Radiology 1990; 174:115-20. 13. Thoeni RF, Fell SC, Engelstad B, Schrock TB. Ileoanal pouches: comparison of CT, scintigraphy, and contrast ene- mas for diagnosing postsurgical complications. AJR Am J Roentgenol 1990;154:73-8. 14. Gelfand DW. Complications of gastrointestinal radiologic procedures: I. Complications of routine fluoroscopic studies. Gastrointest Radiol 1980;5:293-315. 15. Dellinger RP, Carlet JM, Masur H, Gerlach H, Calandra T, Cohen J, et al. Surviving Sepsis Campaign guidelines for management of severe sepsis and septic shock. Crit Care Med 2004;32:858-73. 16. Lee MR, Lee MJ, Kim JH, Hwang Y. Is barium enema prior to ileostomy closure necessary? J Korean Soc Coloproctol 2006;22:298-300. 91