When is CT with rectal contrast indicated in patients suspected with anastomotic leak?
DOI:
https://doi.org/10.51496/jogm.v1.31Keywords:
Reversal of Hartmann's procedure, Anastomotic Leak, Computerised Tomography (CT), Rectal Contrast, Luminal ContrastAbstract
There is no clear guidance about the use of intraluminal rectal contrast combined with computerised tomography (CT) scan when assessing for anastomotic leak (AL) following colorectal resections. ALs most commonly manifest after post-operative day 5, presenting with fevers, abdominal pain, tachycardia and rising inflammatory markers. However, some patients with AL also present with subtle symptoms and failure to progress. CT with or without luminal contrast is the most commonly used investigation for diagnosis; however, there is no consensus on the best protocol. This case report highlights a need for having criteria, which include intra- and post-operative pointers when having a luminal contrast may aid diagnosis, in difficult cases. Studies show that routine contrast enema is not recommended, and furthermore, no gold standard investigation is available. This case report explores the need for a low threshold to use rectal contrast in CT in cases of prolonged ileus.
References
Kaur P, Karandikar S, Roy-Choudhury S. Accuracy of multidetector CT in detecting anastomotic leaks following stapled left-sided colonic anastomosis. Clin Radiol 2014; 69(1): 59–62. doi: 10.1016/j.crad.2013.08.006 DOI: https://doi.org/10.1016/j.crad.2013.08.006
An V, Chandra R, Lawrence M. Anastomotic failure in colorectal surgery: where are we at? Indian J Surg 2018; 80(2): 163–70. doi: 10.1007/s12262-018-1745-0 DOI: https://doi.org/10.1007/s12262-018-1745-0
Frouws M, Snijders H, Malm S, Liefers G, Van de Velde C, Neijenhuis P, et al. Clinical relevance of a grading system for anastomotic leakage after low anterior resection: analysis from a National Cohort Database. Dis Colon Rectum 2017; 60(7): 706–13. doi: 10.1097/DCR.0000000000000800 DOI: https://doi.org/10.1097/DCR.0000000000000800
Nicksa GA, Dring RV, Johnson KH, Sardella WV, Vignati PV, Cohen JL. Anastomotic leaks: what is the best diagnostic imaging study? Dis Colon Rectum 2007 Feb; 50(2): 197–203. doi: 10.1007/s10350-006-0708-x DOI: https://doi.org/10.1007/s10350-006-0708-x
Reynolds I, Boland M, Reilly F, Deasy A, Majeed M, Deasy J, et al. C-reactive protein as a predictor of anastomotic leak in the first week after anterior resection for rectal cancer. Colorectal Dis 2017; 19(9): 812–8. doi: 10.1111/codi.13649 DOI: https://doi.org/10.1111/codi.13649
Damrauer S. Contained anastomotic leaks after colorectal surgery. Archiv Surg 2009; 144(4): 333. doi: 10.1001/archsurg.2008.589 DOI: https://doi.org/10.1001/archsurg.2008.589
Ricciardi R, Roberts PL, Marcello PW, Hall JF, Read TE, Schoetz DJ. Anastomotic leak testing after colorectal resection: what are the data? Arch Surg 2009 May; 144(5): 407–11. doi: 10.1001/archsurg.2009.43 DOI: https://doi.org/10.1001/archsurg.2009.43
Marres C, Engelmann E, Buskens C, Haak H, Bemelman W, van de Ven A. The importance of rectal contrast in CT assessment to detect anastomotic leakage after colorectal surgery. Colorectal Dis. 2021; 00: 1–6. doi: 10.1111/codi.15764 DOI: https://doi.org/10.1111/codi.15764
Thomas MS, Margolin DA. Management of colorectal anastomotic leak. Clin Colon Rectal Surg 2016 Jun; 29(2): 138–44. doi: 10.1055/s-0036-1580630 DOI: https://doi.org/10.1055/s-0036-1580630
Kauv P, Benadjaoud S, Curis E, Boulay-Coletta I, Loriau J, Zins M. Anastomotic leakage after colorectal surgery: diagnostic accuracy of CT. Eur Radiol 2015; 25(12): 3543–51. doi: 10.1007/s00330-015-3795-z DOI: https://doi.org/10.1007/s00330-015-3795-z
Huiberts A, Dijksman L, Boer S, Krul E, Peringa J, Donkervoort S. Contrast medium at the site of the anastomosis is crucial in detecting anastomotic leakage with CT imaging after colorectal surgery. Int J Colorectal Dis 2015; 30(6): 843–8. doi: 10.1007/s00384-015-2215-9 DOI: https://doi.org/10.1007/s00384-015-2215-9
Published
How to Cite
License
Copyright (c) 2021 Sathyaseelan Arumugam, Emily Leivers , Ishmael Chasi
This work is licensed under a Creative Commons Attribution 4.0 International License.
Journal of Global Medicine | Editor-in-Chief: Olufunso Adedeji. MBBS, MD, FRCSEd. 
