Anastomotic Leaks: What is the Best Diagnostic Imaging Study?

Nicksa, G. A.; Dring, R. V.; Johnson, K. H.; Sardella, William V.; Vignati, Paul V.; Cohen, Jeffrey

doi:10.1007/s10350-006-0708-x

Cited by 98 publications

(69 citation statements)

References 20 publications

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“…This observation opens the discussion whether to perform radiographic imaging before relaparotomy. Nicksa et al [16] retrospectively studied 36 patients who were reoperated for anastomotic leakage and found that 3 of the 18 contrast enemas (17%) and 14 of the 27 CT scans (52%) were false-negative. Another study described 16 patients with a clinical anastomotic leakage, in whom four imaging studies (25%) were initially misinterpreted [17] .…”

Section: Discussionmentioning

confidence: 99%

Factors determining delay in relaparotomy for anastomotic leakage after colorectal resection

Doeksen

Tanis²,

Vrouenraets³

et al. 2007

WJG

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AIM:To analyze the time interval ('delay') between the first occurrence of clinical parameters associated with anastomotic leakage after colorectal resection and subsequent relaparotomy. METHODS:In 36 out of 289 consecutive patients with colorectal anastomosis, leakage was confirmed at relaparotomy. The medical records of these patients were retrospectively analysed and type and time of appearance of clinical parameters suggestive of anastomotic leakage were recorded. These parameters inc lude d he ar t rate, body temperature, local or generalized peritoneal reaction, leucocytosis, ileus and delayed gastric emptying. Factors influencing delay of relaparotomy and consequences of delayed recognition and treatment were determined. RESULTS:First documentation of at least one of the predefined parameters for anastomotic leakage was after a median interval of 4 ± 1.7 d after the operation. The median number of days between first parameter(s) associated with leakage and relaparotomy was 3.5 ± 5.7 d. The time interval between the first signs of leakage and relaparotomy was significantly longer when CONCLUSION:An intervening weekend and negative diagnostic imaging reports may contribute to a delay in diagnosis and relaparotomy for anastomotic leakage. That delay was more than two days in two-thirds of the patients.

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Section: Discussionmentioning

confidence: 99%

Factors determining delay in relaparotomy for anastomotic leakage after colorectal resection

Doeksen

Tanis²,

Vrouenraets³

et al. 2007

WJG

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“…Our review shows that CT with Gastrografin provided the most reliable differential diagnosis between POI and mechanical obstruction (LOE: 1c) [25]. Our previous systematic review regarding the detection of anastomotic leakage also demonstrated it to be a reliable diagnostic tool [41], which may assist the differential diagnosis between POI and septic ileus, due to anastomotic leakage by radiological manifestations such as the existence of extraluminal contrast, perianastomotic air, and fluid collections in the CT scan as adjuvants to the clinical manifestations and laboratory tests [42,43]. These integrated results suggest that CT scan should be recommended when suspicion is aroused.…”

Section: Discussionmentioning

confidence: 99%

Clinical Endpoint, Early Detection, and Differential Diagnosis of Postoperative Ileus: A Systematic Review of the Literature

Wu¹,

Boersema²,

Dereci³

et al. 2014

Eur Surg Res

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Background: This systematic review summarizes evidence regarding clinical endpoints, early detection, and differential diagnosis of postoperative ileus (POI). Methods: Using MEDLINE, EMBASE, Cochrane, and Web-of-Science, we identified 2,084 articles. Risk of bias and level of evidence (LOE) of the included articles were determined, and relevant results were summarized. Results: Eleven articles were included, most of which with substantial risks of bias. Bowel motility studies revealed that defecation together with solid food tolerance is the most representative clinical endpoint of POI (LOE: 2b); other clinical signs (e.g. bowel sounds, passage of flatus) did not correlate with a full recovery of bowel motility. Inflammatory parameters including interleukin (IL)-6, IL-1, and TNF-α might assist in an early detection of prolonged POI (LOE: 4). Clinical manifestations (e.g. nausea, vomiting, abdominal distension, bowel sounds, flatus) and X-ray examinations provided limited aid to the differential diagnosis of POI, while CT with Gastrografin had the best specificity and sensitivity (both 100%; LOE: 1c). Conclusions: Postoperative defecation together with tolerance of solid food intake seems to be the best clinical endpoint of POI. CT has the best differential diagnostic value between POI and other complications. Prospective studies with a high LOE are in great need. © 2014 S. Karger AG, Basel

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“…[12] Besides clinical indicators, many biochemical and radiological tests have been studied with the expectation of timely diagnosis. [13,14] A recent study using CRP as an indicator of anastomotic leakage after colorectal resection showed that higher levels might help to detect the leage before becoming clinically apparent. [15] The detection of cytokines through intraperitoneal microdialysis has also been implicated as a tool for detection of anastomotic leakage prior to the emerging of clinical symptoms.…”

Section: Discussionmentioning

confidence: 99%