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segments of the bowel to have the same diameter. The end to side is usually used when the lumens are of different sizes (i.e., ileocolostomy) or for bypass with exclusion. The side to side is the least likely to leak, but is the least physiologic and may lead to the formation of a blind loop. In the early postoperative period, edema at the anastomotic site is expected (Fig. 6.10). In the later postoperative period, the end-to-end anastomotic site is often identified on barium enema as an area of mild

Figure 6.10. End-to-end anastomosis with edema at the anastomotic site.

Oblique view from a water-soluble enema in the early postoperative period shows narrowing at the anastomotic site from edema.

Figure 6.10. End-to-end anastomosis with edema at the anastomotic site.

Oblique view from a water-soluble enema in the early postoperative period shows narrowing at the anastomotic site from edema.

narrowing (Fig. 6.11). If staples have been used, they will be apparent as well. The normal end-to-end colonic anastomosis should be pliable and distensible. An end-to-side anastomosis can be a source of confusion and may lead to an erroneous diagnosis of anastomotic leak (Fig. 6.12). A long side segment of bowel should generally be avoided, since it might act as a blind loop. Side-to-side anastomoses are usually easily identified (Fig. 6.13).

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