How is a dye test for ileostomy reversal done?

Written by andy pasquesi
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Whether used in the treatment of Crohn's Disease or colon cancer, an ileostomy is a procedure wherein a section of the small intestine is pulled through the skin and opened with a special hole called a "stoma." A doctor attaches a special medical device, known colloquially as a "bag," to the abdomen, allowing fecal waste (aka "stool") from the gastrointestinal tract to exit the body through the stoma instead of the large intestine and anus.

When a physician and patient decide it's time to "reopen" the large intestine for use, a surgeon performs an ileostomy reversal. Other common names for this procedure include "ileostomy closure" and "Ileal Pouch Anal Anastomosis."

Before a surgeon can perform an ileostomy reversal, he will order a "pouchogram": a fluoroscopic X-ray that requires a barium-based "contrast dye" to be sent into the small intestines through the stoma. Unlike the stationary images produced by traditional X-ray imaging, fluoroscopy allows for images to be taken in rapid succession, yielding an animation of the intestines and stoma in action. The fluoroscopic X-rays will allow the surgeon to see how well the ileostomy has healed and whether there are any complications such as leaks, strictures (a narrowing of the intestines), vaginal fistula (an accidental link formed between the intestines and the vagina) or excessive scarring.

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Preparation

For the 24 hours leading up to the test, the patient isn't allowed to eat solid foods or drink dairy products. Instead, she may only drink clear fluids (i.e. without pulp) such as juice, tea, coffee, carbonated beverages and broth. After midnight, she cannot eat or drink anything. However, daily medications may be taken with a very small amount of water.

Administering The Dye

At the radiologist's office, the patient will remove all clothes and jewellery before putting on a paper gown. In the fluoroscopy room, the patient will lie down on the radiographic table while a nurse removes the patient's bag and routes a catheter into the stoma. A hanging bag of barium dye solution equipped with a gravity drip is attached to the catheter. Once the dye has drained fully into the small intestines, the radiologist will ask the patient to lie on one side while the fluoroscope records images. The patient will then change sides and probably take several other positions for the fluoroscope. Note: The contrast dye will cause mild to severe cramping pains in the small intestines, so patients should except some discomfort.

Removing The Dye

The fluoroscopy takes about 30 minutes, then the catheter is removed. A nurse usually reattaches the bag to the stoma, so the patient can drain the dye from her stomach and dispose of it in the toilet. The patient can then get dressed and go home.

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