Diagnosis of Anastomotic Leak

Abstract

Anastomotic leaks after colorectal surgery is associated with increased morbidity and mortality. Understanding the impact of anastomotic leaks and their risk factors can help the surgeon avoid any modifiable pitfalls. The diagnosis of an anastomotic leak can be elusive but can be discerned by the patient's global clinical assessment, adjunctive laboratory data and radiological assessment. The use of inflammatory markers such as C-Reactive Protein and Procalcitonin have recently gained traction as harbingers for a leak. A CT scan and/or a water soluble contrast study can further elucidate the location and severity of a leak. Further intervention is then individualized on the spectrum of simple observation with resolution or surgical intervention.

Keywords: CT scan; anastomosis; complications; leak.

Fig. 1

CT scan and fluoroscopy with extra-luminal contrast via anastomotic leak (arrows).

Fig 2

CT scan ( A ) magnetic resonance imaging ( B & C ) and fluorodeoxyglucose-positron emission tomography (FDG-PET) imaging ( D ) used to distinguish persistent leak from tumor recurrence or inflammatory changes.

Fig. 3

CT scans with perianastomotic fat stranding ( A ) and gas and fluid collections ( B & C ) have high sensitivity for leak; mural edema of the bowel ( D & E ).

Fig. 4

CT scans with contrast extravasation outside the bowel lumen (arrows).

Fig. 5

CT scan and fluoroscopy indicating contrast extravasation and AL.

Fig. 6

CT scan and fluoroscopy indicating complex collections and fistulas (arrows) in delayed AL.