Give it to me straight--the leak test

[JudeD59]

I'm the type person who has less anxiety if I have a very clear picture of what to expect with procedures. I'm scheduled for my leak test on February 10th, so if anyone would be willing to take the time to give a detailed description of exactly what to expect, I would greatly appreciate it.

I know the basics of why they do it and pretty much how they do it, but any other advice, tips, hints, or details you can offer would help put my mind at ease. I had a barium enema once before, but I was very young and hadn't gone through all this bowel reconstruction. I remember it feeling like an electric shock up my butt because the flow was so powerful. I hope it will be delivered a little gentler this time. I also remember, being a person who still had a little dignity at that time, being embarrassed to have the volcanic explosions of the barium when it was finished in a small bathroom with a bunch of technicians right outside the door, but after this past year, I'm past being embarrassed over bathroom habits. Besides, they must hear it a lot.

I have questions like--How long do you have to hold it in? What if you can't hold it in? Do they do x-rays or a CT scan? Why do you have to do a day of liquid only prep the day before when anything you eat should be going in the bag anyway? Did anyone take a Depends with them for the ride home just in case? Do you lay on your side while it is administered?

I'm not really all that concerned about the leak test. It's minor compared to all the stuff we go through. I just feel a bit more in control if I know what to expect going in.

Thanks!

Judy

[megan120]

I just had my leak test last week. I also had one in June before my end ileostomy was taken down and my loop ileostomy was formed. I didn't tolerate the one in June very well, the tube for the barium was too painful, so they used a foley catheter with gastrografin instead. I also leaked that time, which was ridiculously embarrassing for me even though they reassured me that it happens all the time. I cried. Last week they just started with the foley tube with gastrografin, and it was much more tolerable for me. I didn't cry or leak this time.

I laid on my left side to have the tube inserted. They put the contrast up, and took xrays. I had to move around onto my back, up onto my right side, back onto my back, while they watched the contrast move up through my rectum and ileum up to my ostomy. The tech had to hold the tube in my butt, which was a bit embarrassing, but I guess it was probably better than having to have the tube replaced if it fell out. They stopped and started the contrast as needed to get the pictures they needed. I am horrible at estimating time, but I would guess it took about 20 minutes from start to finish. Initially I was pretty uncomfortable with the contrast, but as it went further up my rectum and into my ileum the pressure was less. I was worried that I would leak on my mad dash to the toilet, but I didn't. It took a few times in the bathroom before I felt like I was safe to make the 30 min drive home, but after that I was ok for the rest of the day. There was some blood in the contrast both times I had the test. The radiologist was not concerned either time, so maybe that is kind of normal?

I had the liquid diet the day before as well, but I also pass quite a bit of poop through my butt, so the liquid diet made sense for me. I would guess that any solid-ish stool in any part of the bowel could show up on the x-rays and distort the pictures? I really think that they just give the same instructions for everyone and they just don't like to deviate from them.

Good luck with your test!
Megan

[Buckeye]

I had my leak test January 11. I would recommend bringing a pad or some depends if you have a long ride home . You may or may not need them, but better safe than sorry . The technician at the hospital gave me some extra pads yours may do the same. Plan on walking around the hospital and grabbing a soda for a least 40 minutes after procedure. It will help move everything through before ride home.

Now as for the procedure itself. If you have an illoestomy bag make sure it is completely empty, mine filled up to almost bursting with the barium. They lay you on your left side after they take a first X-ray to check your gas patterns . They used a pediatric tip for me and asked me to "clinch " down to keep it in. For the record that is impossible to do although I did try my best. They make you roll onto your back and right side while tube is inserted to take pictures of every angle of your reconnect. The most uncomfortable part for me Was the pressure of the ennama going up and into my small intestine and into my bag. It was somewhat painful,but the ennama fluid was not . I have IBS as well and gas pains are the worst for me. After that it is basically over with. They actually suck the barium out of you and into a container. That was a great feeling. While they were doing that I was looking at the tv monitor which showed my X-ray and started asking questions. The radiologist was very informative and showed me my reconnect the staples and such while fluid was being drained. The whole thing probably took 15-20 mins. Good luck with your procedure and I pray you have no leak.

[BrownBagger]

No fun, but not the worst thing you've had to endure. For the record, I didn't leak either internally or externally, and I had an hour-long drive home afterward.

[O Stoma Mia]

I'm the type person who has less anxiety if I have a very clear picture of what to expect with procedures. I'm scheduled for my leak test on February 10th, so if anyone would be willing to take the time to give a detailed description of exactly what to expect, I would greatly appreciate it...

This may not be relevant to your case, but, for the record, this is what I remember about my leak test:

The leak-test session had two objectives:

1. Anastomosis patency check: In this phase, they try to determine if the anastomosis has a large-enough opening. Phase 1. In this phase, they give a mild sedative and use a small pediatric colonoscope to see if it is possible for the small colonoscope to reach the other side of the anastomosis. In other words, it is a check to see if the anastomosis has any opening at all, or if it has been completely closed off by scar tissue or adhesions. If this test is successful (i.e., they are able to push the pediatric colonoscope through to the other side) they then proceed to Phase 2. In Phase 2 they increase the dose of the sedative so that the patient won't feel anything from this point onward. After the sedative has taken effect, they then attempt to pass a normal-size adult colonoscope through the opening that they just found earlier using the pediatric colonoscope. If they manage to get the adult colonoscope to go all the way through, then the test is successful. If not, then the test fails and they postpone the reversal until they can do something about increasing the size of the opening. (The opening must be large enough to accommodate an adult colonoscope, because colonoscopies will be required later on, and every three years subsequently. If the opening is not large enough, they will need to do the repairs now, not later.)
2. Leak test: If the above tests are successful, then they do the set-up for the leak test. I think the way it works is like this (but I don't know for sure, since I was under heavy sedation from this point onward): They insert a special catheter that has an inflatable balloon at the end. When they inflate the balloon, the catheter then serves as a plug that prevents anything from coming out during the leak test. They then use the catheter to force contrast solution up into the rectal area, far enough to fill up the anastomosis and the neo-rectum area. When this part of the colon/rectum is full of contrast solution, then they use some kind of portable X-ray machine or fluoroscope to check whether any of the contrast liquid has escaped from the colon. If they don't see any leaks on the image, they then release the clamp on the catheter to allow the contrast fluid to escape. After all of the fluid has drained out, they then deflate the balloon completely so that they can gently remove the catheter. I think they also have something like a bed-pan there to handle any fluid that may come out after the catheter has been removed. The nurses handled all of the clean up necessary, and when I finally woke up from the anaesethesia, the doctor told me that the test had been successful and that I was ready to be discharged.
   
   This is what I remember about my experience. It may be a different procedure in your case.

[JudeD59]

I'm the type person who has less anxiety if I have a very clear picture of what to expect with procedures. I'm scheduled for my leak test on February 10th, so if anyone would be willing to take the time to give a detailed description of exactly what to expect, I would greatly appreciate it...

This may not be relevant to your case, but, for the record, this is what I remember about my leak test:

The leak-test session had two objectives:

1. Anastomosis patency check: In this phase, they try to determine if the anastomosis has a large-enough opening. Phase 1. In this phase, they give a mild sedative and use a small pediatric colonoscope to see if it is possible for the small colonoscope to reach the other side of the anastomosis. In other words, it is a check to see if the anastomosis has any opening at all, or if it has been completely closed off by scar tissue or adhesions. If this test is successful (i.e., they are able to push the pediatric colonoscope through to the other side) they then proceed to Phase 2. In Phase 2 they increase the dose of the sedative so that the patient won't feel anything from this point onward. After the sedative has taken effect, they then attempt to pass a normal-size adult colonoscope through the opening that they just found earlier using the pediatric colonoscope. If they manage to get the adult colonoscope to go all the way through, then the test is successful. If not, then the test fails and they postpone the reversal until they can do something about increasing the size of the opening. (The opening must be large enough to accommodate an adult colonoscope, because colonoscopies will be required later on, and every three years subsequently. If the opening is not large enough, they will need to do the repairs now, not later.)
2. Leak test: If the above tests are successful, then they do the set-up for the leak test. I think the way it works is like this (but I don't know for sure, since I was under heavy sedation from this point onward): They insert a special catheter that has an inflatable balloon at the end. When they inflate the balloon, the catheter then serves as a plug that prevents anything from coming out during the leak test. They then use the catheter to force contrast solution up into the rectal area, far enough to fill up the anastomosis and the neo-rectum area. When this part of the colon/rectum is full of contrast solution, then they use some kind of portable X-ray machine or fluoroscope to check whether any of the contrast liquid has escaped from the colon. If they don't see any leaks on the image, they then release the clamp on the catheter to allow the contrast fluid to escape. After all of the fluid has drained out, they then deflate the balloon completely so that they can gently remove the catheter. I think they also have something like a bed-pan there to handle any fluid that may come out after the catheter has been removed. The nurses handled all of the clean up necessary, and when I finally woke up from the anaesethesia, the doctor told me that the test had been successful and that I was ready to be discharged.
   
   This is what I remember about my experience. It may be a different procedure in your case.

Wow. I actually already had my leak test on Wednesday. That is so very different from what I experienced. No sedative, mild or otherwise. No pediatric colonoscope, just an adult one from the get go. Wide awake and in a great deal of pain. For more details, check out my experience at viewtopic.php?f=1&t=53686

Thank you for going into so much detail though. I appreciate the effort a lot. I'm not sure where you had yours done, but I don't think most hospitals give any sedative for a leak test/barium contrast enema. I sincerely wish they had done mine they way they did yours.

Judy

[JudeD59]

I'm not really all that concerned about the leak test. It's minor compared to all the stuff we go through. I just feel a bit more in control if I know what to expect going in.

Thanks!

Judy

Do you think I'll ever learn to not say stupid things like this and regret them bitterly later? Probably not.

Sigh.

Judy

[Rob in PA]

My "cliff's notes"....

Ask for pediatric tube.
Expect some cramping while they pump it in.
Don't worry if it leaks out while on the table, they put enough in to still get a good read.
You lie on your side.
Throw dignity out the window for this one.
Don't be in a hurry to leave, find a private toilet and spend about half hour letting the barium drain out.

Good luck!

[JudeD59]

My "cliff's notes"....

Ask for pediatric tube.
Expect some cramping while they pump it in.
Don't worry if it leaks out while on the table, they put enough in to still get a good read.
You lie on your side.
Throw dignity out the window for this one.
Don't be in a hurry to leave, find a private toilet and spend about half hour letting the barium drain out.

Good luck!

Thanks, Rob, but I already had the test last Wednesday and it went very poorly. Details are in thread called "Not sure why this happened". I asked for pediatric tube and was told tube they would be using was standard for this test, so in other words, no.

Thanks for the cliff notes, though. Perhaps they will help someone else out in future.

Judy