Distal Pressure Colostogram Flashcards
Indications for a distal pressure colostogram
- completed prior to colostomy reversal/anoplasty in babies with imperforate anus
- Eval for recto-urethral, recto-vesicular, recto-something fistula
- measure distance between the end of the rectal stump and the external anal verge (gestimate is ok)
Colostogram set up
- Contrast
- Steps to procedure, table/positioning
- Machine Settings
Contrast
- Cystografin
- cystoconray II
How to administer the contrast: hand inject via foley placed into the mucus fistula (usually 8 Fr)
Table/positioning
- Horizontal, start AP
- Inflate the balloon UNDER FLUORO
- Have tech pull back on the catheter to make sure the balloon is really being used to help w/ seal
- Fill under cine loops just to watch closely but don’t need to save these images
- Once rectum distended, take exposure or last-image hold
- Turn LATERAL w/ rectum distended, make sure rectum is really full then take exposure or last image hold
- At any point if you see a fistula or the bladder filling with contrast, take exposures also
- pull back on syringe and remove as much contrast as possible, deflate balloon, remove catheter.
- Post-evac image (either exposure or last image hold)
Machine Settings: 3p/s, 0.5f/s
Colostogram tips/tricks
- place a radiopaque marker overlying the anal verge (guestimate is ok) so can measure the distance between the end of the rectal stump and the marker (not an exact science)
- always go through the mucus fistula for these. Sometimes the parents don’t know which one the fistula is, double check the Op reports if needed to confirm
- make sure parents or tech have new bag to replace at the end of the study. Bag will be more full than normal because of the contrast that will leak out of the mucus fistula. Some bleeding is normal
- FYI: most of these babies have some sort of fistulous communication with the urethra/bladder but many (most) of the time you can’t demonstrate it. That’s ok. the surgeons know this.
