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Gastrointestinal Imaging

E2856. Colostomy on CT and Fluoroscopy: What the Radiologist Needs to Know

Ekinci T1,  Mazzariol F2,  Stein M2,  Ricci Z2,  Wolf E.2 1. St. Vincent's Medical Center, Bridgeport, CT; 2. Montefiore Medical Center, Bronx, NY

Address correspondence to F. Mazzariol (fmazzariolgunduz@gmail.com)

Background Information: Approximately 100,000 americans undergo a surgery which will end with an ostomy every year. Early and late colostomy complications vary and patients may need CT scan or fluoroscopic exam for diagnosis. It is important for the radiologist to be familiar with the imaging appearance of colostomies and their complications to provide a confident diagnosis.

Educational Goals/Teaching Points: 1.The most common types of colostomies are: loop colostomy, double-barrel colostomy, end colostomy and end colostomy with mucous fistula 2.There are various indications for temporary and permanent colostomy 3.Common complications include parastomal hernia and prolapse 4.CT is most helpful for diagnosis of parastomal hernia 5.Nipple tip devices to facilitate the performance of fluoroscopy colostomy studies are commercially available

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques: 1. Illustrated examples of: a) end colostomy with and without mucous fistula, b) loop colostomy and c) double -barrel colostomy 2. Illustrated examples of indications for temporary colostomies: a) decompress large bowel obstruction, b) diversion of fecal stream to protect surgical anastomosis, c) Hartmann surgery for diverticulitis 3. Illustrated examples of indications for permanent colostomies: a) colonic/rectal malignancy and b) severe fecal incontinence (rare) 4. Proper fluoroscopic technique for colostomy study 5. Illustrated examples of colostomy complications: a) parastomal hernia, b) stomal prolapse, c) colostomy stenosis, d) disuse microcolon, e) diversion colitis and f) leak 6. Illustrated examples of complications post reversal of colostomy: a) leak, b) abscess, c) stricture at the anastomosis and d) hernia

Conclusion: The radiologist will be more confident to diagnose colostomy complications after reviewing this exhibit.