[size=20px]An ex-25-week premature infant underwent laparotomy, small bowel resection, and end ileostomy with mucus fistula for necrotizing enterocolitis (NEC). She is now 48 weeks corrected gestational age. She is tolerating enteral feeds, gaining weight and has been weaned to room air. The Neonatology teams asks if any additional testing is required prior to ostomy reversal.

 

A Contrast studies are not required prior to ostomy reversal so no further testing is needed​

 

B Contrast studies are only needed in patients who have difficulty tolerating enteral feeds, so no further testing is needed in this case

 

C Contrast studies should be obtained prior to ostomy reversal in cases of NEC and anorectal malformations, but can be avoided in other diagnoses

 

D Contrast studies should always be performed prior to ostomy reversal, regardless of the underlying diagnosis​[/size]

C

C

C

C

Correct Answer

C Contrast studies should be obtained prior to ostomy reversal in cases of NEC and anorectal malformations, but can be avoided in other diagnoses

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​Based on the paper by Schattenkerk et al., patients with NEC should have an antegrade (through the mucus fistula) or retrograde (through the anus) contrast enema prior to ostomy reversal. In their study, the overall stricture rate was 10% and 96% of those patients had NEC. More than 20% of patients with NEC who were undergoing ostomy reversal had a stricture identified. As a result, the authors recommended that contrast enema should be used in patients with NEC but can be avoided in most other diagnoses.​

 

​Importantly, children with anorectal malformations were excluded from this study. These patients should always undergo contrast study prior to ostomy reversal.​

 

 

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