Klinische Bedeutung des abführenden Schenkels im Vergleich zur Rektoskopie in der Diagnostik vor Ileostomarückverlagerung

Clinical significance of the radiological representation of the descending intestinal loop in comparison to rectoscopy in the diagnosis before ileostomy relocation

by Maximilian Clemens
Doctoral thesis
Date of Examination:2020-08-18
Date of issue:2020-07-23
Advisor:Prof. Dr. Jochen Gaedcke
Referee:Prof. Dr. Jochen Gaedcke
Referee:Prof. Dr. Dr. Albrecht Neeße
Referee:Prof. Dr. René Müller-Wille
Persistent Address: http://dx.doi.org/10.53846/goediss-8121

 

 

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Abstract

English

In the context of visceral resections, the creation of an artificial bowel outlet (stoma) may be necessary. Among other aspects, the protective double loop ileostomy has become established. One lumen, which conveys the chyme, and one which runs to the anus without conveying any contents. This is the so-called "descending intestinal loop". Since this stoma is usually only temporarily upstream, affected patients can be subjected to surgical ileostomy repositioning (IRV). This requires special preoperative diagnostics including rectoscopy (RS) with a digital-rectal examination and radiological imaging of the „descending intestinal loop“ (AS) in order to rule out any anastomosis stenoses, insufficiencies, as well as tumor recurrence, and possible inflammatory changes, or to assess sphincter function and continence performance. Both methods are established and are used individually or in combination. At the University Medical Center Göttingen (UMG) it is common practice to use both methods as standard procedures. However, there is no sufficient scientific basis for this procedure in the literature. The aim of this study was to investigate the clinical significance of AS compared to RS in the diagnosis prior to IRV. 150 patients, who received IRV at the University Medical Center Göttingen (UMG) were examined retrospectively and anonymously. The results were compared and evaluated in a frequency table. The data obtained show that, in the absence of AS in this sample 40 % (n = 6) of patients with contraindications for IRV (n = 15) would not have been detected. This makes the additional use of the AS useful. On the other hand, an inconspicuous RS finding leads with 92 % conditional probability to the same inconspicuous result in the AS. Furthermore, 3 patients (20 %) could be recognized as inoperable solely by the RS. It therefore remains obligatory. The results speak in favour of continuing to use both procedures as a standard at present.
Keywords: descending intestinal loop; stoma; ileostomy; preoperative diagnostics; rectoscopy; surgery
 
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