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European Journal of Trauma and Emergency Surgery
Published in: European Journal of Trauma and Emergency Surgery 5/2020

01-10-2020 | Computed Tomography | Original Article

Computed tomography in suspected anastomotic leakage after colorectal surgery: evaluating mortality rates after false-negative imaging

Authors: Nicolò Tamini, Diletta Cassini, Alessandro Giani, Marco Angrisani, Simone Famularo, Massimo Oldani, Mauro Montuori, Gianandrea Baldazzi, Luca Gianotti

Published in: European Journal of Trauma and Emergency Surgery | Issue 5/2020

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Abstract

Purposes

We sought to investigate the accuracy of abdominal CT scanning for anastomotic leakage and the effect of false-negative scans on the delay in therapeutic intervention and clinical outcome.

Method

Data from a prospectively bi-institutionally maintained database of all patients who underwent elective colorectal surgery with primary anastomosis for malignant or benign disease between 2010 and 2017 were reviewed. Patients with confirmed anastomotic dehiscence at reintervention who underwent a postoperative CT scan for suspected leakage were identified and radiological reports were retrieved.

Results

Seventy-six patients with anastomotic dehiscence were included in the study. American Society of Anesthesiologists score, sex, type of surgical procedure, malignancy, and type of anastomosis do not correlate with postoperative false-negative CT imaging. Postoperative false-negative CT scan, however, led to delayed reintervention (3 vs. 6 h, p = 0.023) and increased mortality (five deaths vs. no deaths, p = 0.043). Free abdominal air (p = 0.001) and extraluminal contrast extravasation (p = 0.001) were found to be predictive of accuracy in anastomotic leakage diagnosis.

Conclusion

The suboptimal specificity of a postoperative CT scan in suspected anastomotic leakage after colorectal surgery can delay reintervention and increase mortality.
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Metadata
Title
Computed tomography in suspected anastomotic leakage after colorectal surgery: evaluating mortality rates after false-negative imaging
Authors
Nicolò Tamini
Diletta Cassini
Alessandro Giani
Marco Angrisani
Simone Famularo
Massimo Oldani
Mauro Montuori
Gianandrea Baldazzi
Luca Gianotti
Publication date
01-10-2020
Publisher
Springer Berlin Heidelberg
Published in
European Journal of Trauma and Emergency Surgery / Issue 5/2020
Print ISSN: 1863-9933
Electronic ISSN: 1863-9941
DOI
https://doi.org/10.1007/s00068-019-01083-8

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