HARTMANNS POUCH - RADIOGRAPHIC EVALUATION OF POSTOPERATIVE FINDINGS

OBJECTIVE. The purpose of this study was to determine the usefulness o f contrast-enhanced radiography of the Hartmann's pouch for evaluating postoperative abnormalities. MATERIALS AND METHODS. We performed a re trospective study of 84 patients with a Hartmann's pouch who underwent contrast-enhanced radiography of the pouch during a recent 7-year per iod. Sixty-four patients underwent single-contrast barium studies of t he pouch, 17 underwent studies with a water-soluble contrast medium, a nd three underwent both types of studies. The radiographic studies wer e reviewed to determine the types and frequency of abnormalities invol ving the pouch. Medical records were also reviewed to determine clinic al presentation and course. RESULTS. Abnormalities of the Hartmann's p ouch were detected on contrast-enhanced radiography in 16 (19%) of the 84 patients. Of the 70 patients who underwent routine contrast-enhanc ed radiography of the pouch, 11 (16%) had abnormalities, including div ersion colitis in three, leaks in two, adhesions in two, recurrent car cinoma in two, ulcerative colitis involving the pouch in one, and a st ricture in one. In both patients with clinically silent leaks, the con trast-enhanced radiography was performed 3 months or more after creati on of the pouch. Of the remaining 14 patients who underwent contrast-e nhanced radiography because of suspected complications involving the p ouch, five (36%) had abnormalities revealed, including leaks in two, f istulas in two, and recurrent carcinoma in one. CONCLUSION. Contrast-e nhanced radiography of the Hartmann's pouch revealed abnormalities of the pouch in 19% of patients, including leaks or fistulas, diversion c olitis, adhesions, strictures, and recurrent tumor. Because two patien ts had clinically silent leaks that were detected during the late post operative period, it may be prudent to perform these studies with a wa ter-soluble contrast medium to avoid the problems associated with extr avasation of barium into the extra- or intraperitoneal spaces.