Anastomotic Leakage After Bowel Surgery

Two coronal-reformatted CT images of the abdomen show a localized fluid collection (arrows) in the right abdomen, which contains air bubbles, fluid and oral contrast material, in a patient who had recent small bowel resection.

Facts: Anastomotic Disruption

• One of the most fearful complication after intestinal surgery
• Can present early or late. The latter can be difficult to distinguish from other postoperative infectious complications
• In a prospective study of 1223 patients who had intestinal resection and anastomosis without fecal diversion, the incidence of anastomotic leak was 2.7%.
• Location of anastomosis is among the most significant factors associated with leak. Those in the pelvis have a higher rates of leakage
• Clinical presentation: pain, tachycardia, high fevers, rigid abdomen accompanied by hemodynamic instability. Typically, leak is discovered 5-7 days after surgery.

Imaging

• CT is helpful to determine whether there is an associated abscess. Gastrograffin enema may aid the diagnosis of leak.
• Visualization of administered contrast (on CT or enema) is the direct sign of anastomotic leak. Neither CT nor enema is perfect to show the leak, unfortunately.
• Many CT features of postoperative bowel overlap between patients with and without a leak. The most specific feature of a leak is the presence of extraluminal contrast.

Reference:

1. Hyman N, Manchester TL, Osler T, Burns B, Cataldo PA. Anastomotic leaks after intestinal anastomosis. Ann Surg 2007; 245:254-258.

2. Mulholland MW, Doherty GM. Complications in Surgery, 2005.