What exams and tests should be performed for a patient following reversal of a sigmoid colostomy?

Post-Colostomy Reversal Follow-Up Examination and Testing

Following sigmoid colostomy reversal, perform a digital rectal examination to assess anastomotic integrity, evaluate for stricture formation, and check for signs of anastomotic leak, along with baseline laboratory studies including complete blood count, electrolytes, and renal function. 1

Essential Physical Examination Components

Digital Rectal Examination:

• Assess the anastomotic site for tenderness, masses, or irregularities that could indicate leak or stricture 1
• Evaluate sphincter tone and rectal vault capacity 2
• Check for signs of pelvic sepsis or abscess formation 1

Abdominal Examination:

• Palpate for peritoneal signs that could indicate anastomotic leak or perforation 1
• Assess for abdominal distension suggesting early obstruction 1
• Examine the former stoma site for wound complications or herniation 1

Laboratory Testing

Baseline Blood Work:

• Complete blood count to detect infection or anemia 1
• Electrolytes and renal function, as these patients are at risk for dehydration-related renal insufficiency 1
• Consider lactate if there are any concerns about bowel ischemia, though normal lactate does not exclude ischemia 1

Imaging Considerations

Selective CT Imaging:

• CT scan with IV contrast is indicated if you suspect anastomotic leak, abscess, or bowel ischemia based on clinical findings 1
• Plain abdominal radiographs if obstruction is suspected 1
• Routine imaging is not necessary in asymptomatic patients 1

Endoscopic Evaluation

Proctoscopy or Flexible Sigmoidoscopy:

• Perform if there are symptoms suggesting anastomotic complications (bleeding, stricture, incomplete emptying) 1
• Not routinely indicated in asymptomatic patients immediately post-reversal 1
• Consider at 3-6 months if patient develops concerning bowel symptoms 2

Critical Warning Signs to Assess

High-Risk Complications:

• Fever, tachycardia, or hypotension suggesting sepsis from anastomotic leak 1
• Severe abdominal pain or peritoneal signs 1
• Inability to pass stool or flatus suggesting obstruction 1
• Fecal incontinence, urgency, or incomplete emptying (reported in approximately 20-25% of patients post-sigmoid resection) 2

Common Pitfalls

Delayed Recognition of Anastomotic Leak:

• Anastomotic leak rates range from 0-12% depending on patient factors and surgical technique 1
• Absence of peritoneal signs does not exclude early leak or ischemia 1
• Maintain high index of suspicion in patients with persistent pain or fever 1

Functional Bowel Dysfunction:

• Female patients are at higher risk for post-operative fecal incontinence, urgency, and incomplete emptying 2
• These symptoms may not manifest immediately and can develop over weeks to months 2
• Document baseline bowel function for future comparison 2