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. 2017 Sep;21(9):709-714.
doi: 10.1007/s10151-017-1689-6. Epub 2017 Sep 19.

Colorectal anastomotic leak: delay in reintervention after false-negative computed tomography scan is a reason for concern

C C M Marres  1 , A W H van de Ven  2   3 , L G J Leijssen  2 , P C M Verbeek  2 , W A Bemelman  3 , C J Buskens  3
Affiliations

Colorectal anastomotic leak: delay in reintervention after false-negative computed tomography scan is a reason for concern

C C M Marres et al. Tech Coloproctol. 2017 Sep.

Abstract

Background: Early detection of anastomotic leakage (AL) after colorectal surgery followed by timely reintervention is of crucial importance. The aim of this study was to investigate the accuracy of computed tomography (CT) imaging for AL and the effects of delay in reintervention after a false-negative CT.

Methods: All files from patients who had colorectal surgery with primary anastomoses between 2009 and 2014 were reviewed. The predictive value of CT scanning for AL was determined and correlated with short-term postoperative patient outcomes. In addition, factors predictive of false-negative scans were assessed.

Results: Six hundred and twenty-eight patient files were reviewed. In total, a CT scan was performed in 127 patients. Overall, leakage was seen in 49 patients (7.8%). The positive and negative predictive values were 78 and 88%, respectively. Sensitivity was 73% and specificity 91%. In patients with a true-positive CT (n = 24), reintervention followed after a median interval of 0 days (IQR 1), whereas this was 1 day (IQR 2) in the false-negative group (n = 11) (p < 0.05). This was associated with a significantly increased mortality rate (1/24 = 4.2% vs 5/11 = 45.5%) (p < 0.005), an increased length of hospital stay [median 28 days (IQR 26) vs 54 days (IQR 20) (p < 0.05)].

Conclusions: Delayed reintervention after false-negative CT scanning is associated with a high mortality rate and a significant increase in length of hospital stay.

Keywords: Anastomotic leakage; Colorectal surgery; Computed tomography; Oncology.

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Conflict of interest statement

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by the authors.

Informed consent

For this type of study formal consent is not required.

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