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. 2020 Jan 6;9(1):2058460119897358.
doi: 10.1177/2058460119897358. eCollection 2020 Jan.

Radiological findings in anastomotic leakage after anterior resection may predict a permanent stoma

Henrik Jutesten  1 , Marie-Louise Lydrup  1 , Axel Landberg  1   2 , Daniel Risberg  1   2 , Olle Ekberg  2 , Sophia Zackrisson  2 , Pamela Buchwald  1
Affiliations

Radiological findings in anastomotic leakage after anterior resection may predict a permanent stoma

Henrik Jutesten et al. Acta Radiol Open. .

Abstract

Background: Permanent stoma (PS) is common following treatment of anastomotic leakage (AL) after anterior resection (AR) and ways of predicting successful treatment outcome are missing.

Purpose: To explore radiological variables in rectal contrast studies in their relation to end-result of PS following treatment for AL after AR.

Material and methods: The Swedish Cancer Registry (SCRCR) was explored for AL cases after AR for rectal cancer in patients operated in the region of Skåne from 1 January 2001 to 31 December 2011. Among identified AL cases, patients subjected to radiological imaging consistent with AL were evaluated according to a predetermined set of radiological variables. Information of PS as the end-result after AL treatment were retrieved from medical records.

Results: Thirty-two patients had radiological imaging available for analysis confirming AL after AR; PS rate after a median follow-up of 87 months (range = 21-165) after AR was 62%. Radiological findings compatible with abscess (P = 0.023) and a leak size ≤6 mm (P = 0.049) were significantly associated with PS.

Conclusion: In this limited explorative study, our findings suggest that abscess status and leak size could correspond to outcome of PS in treatment for AL after AR. Additional studies are warranted to further explore this subject.

Keywords: Anastomotic leakage; anterior resection; contrast enema; rectal cancer.

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Figures

Fig. 1.
Fig. 1.
A 62-year-old patient with anastomotic leakage after anterior resection. (a) Sagittal image of plain abdominal CT demonstrating fluid and gas dorsal of the rectum (gray arrow). Catheter with inflated balloon in the rectum. White arrows pointing at the anastomotic staple line. (b) Sagittal image off following contrast enema at computed tomography shows a 4-mm leak size dorsally (white arrow) with contrast fluid partly filling the cavity behind rectum.
Fig. 2.
Fig. 2.
A 78-year-old patient with anastomotic leakage after anterior resection. Sagittal image of plain CT visualizing a dorsal cavity with gas and fluid (white arrow) (a) and contrast enema on plain radiography visualizing a wide anastomotic leak size (black arrows) (b).
See this image and copyright information in PMC

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