Is the routine use of a water-soluble contrast enema prior to closure of a loop ileostomy necessary? A review of a single institution experience.

BACKGROUND: The aims of the study were to determine the radiological leak rate in those patients who had undergone a resection for left-sided colorectal cancer and to see if the presence of a leak can be related with the postoperative clinical period. We also aimed to identify any common factors between patients with leak. METHODS: A retrospective analysis of prospectively collected data of all patients who underwent a left-sided colorectal cancer resection with formation of a defunctioning ileostomy was undertaken. Between 2005 and 2010, 418 such patients were identified. RESULTS: A water-soluble contrast enema was performed in 339 patients (81.1 %). Of these, 24 (7.1 %) were reported to show an anastomotic leak. Data for these 24 patients is presented in this study. Twenty-three (95.8 %) of the leaks occurred in patients who had undergone an anterior resection; 95.8 % of the patients with a leak were male. Fifteen (62.5 %) patients underwent neo-adjuvant radiation. The mean length of stay in those patients shown to have a subsequent radiological leak was 18.8 days (median), compared with the overall unit figures of 12 days. Only 29.2 % of the patients who had a leak identified had an uncomplicated postoperative period. Overall 87.5 % of the patients had a reversal of the ileostomy. CONCLUSIONS: Radiological leakage is not uncommon. The majority of patients, who were shown to have a radiological leak in this study, were male, had undergone an anterior resection, had received neo-adjuvant radiation, had a longer initial length of stay and had postoperative complications. Water-soluble contrast enemas could be selectively used in patients with these characteristics.

Teaching digital rectal examination to medical students using a structured workshop-a point in the right direction?

BACKGROUND: Digital rectal examination (DRE) is an important skill in the investigation of rectal symptoms. This frequently performed examination is poorly taught and while students agree it is an important skill, their experience is often limited. Studies have suggested that structured teaching can improve confidence, knowledge, and ability of DRE. METHOD: Medical students from the University of Leicester attended a teaching program in DRE. It consisted of a lecture followed by objective structured clinical examination stations. These stations included the teaching of communication skills, utilized interactive scenarios, and DRE training with mannequins. Students were asked to complete an evaluation questionnaire that assessed their skill level both prior to and following the workshop. RESULTS: A total of 377 students completed the workshop and all completed our questionnaire; 228 students (63.5%) had not previously performed a DRE. Before the workshop, 55% (199/360) were not confident in performing a DRE at all. Following the workshop, 19% (68/358) of students felt confident to perform a DRE independently, and the majority, 68% (223/358) felt confident to perform a DRE on a patient under supervision. The mean score following the workshop was 4.87, improving from 2.22 before the workshop. A Student t-test showed this improvement was statistically significant (p < 0.0001, 95% CI 2.65-2.64). CONCLUSIONS: The overwhelming feedback to our program is extremely favorable and demonstrates that medical students clearly benefit from a structured, interactive, and hands-on educational workshop in DRE.