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Techniques in Coloproctology
Published in: Techniques in Coloproctology 9/2017

Open Access 01-09-2017 | Original Article

Colorectal anastomotic leak: delay in reintervention after false-negative computed tomography scan is a reason for concern

Authors: C. C. M. Marres, A. W. H. van de Ven, L. G. J. Leijssen, P. C. M. Verbeek, W. A. Bemelman, C. J. Buskens

Published in: Techniques in Coloproctology | Issue 9/2017

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Abstract

Background

Early detection of anastomotic leakage (AL) after colorectal surgery followed by timely reintervention is of crucial importance. The aim of this study was to investigate the accuracy of computed tomography (CT) imaging for AL and the effects of delay in reintervention after a false-negative CT.

Methods

All files from patients who had colorectal surgery with primary anastomoses between 2009 and 2014 were reviewed. The predictive value of CT scanning for AL was determined and correlated with short-term postoperative patient outcomes. In addition, factors predictive of false-negative scans were assessed.

Results

Six hundred and twenty-eight patient files were reviewed. In total, a CT scan was performed in 127 patients. Overall, leakage was seen in 49 patients (7.8%). The positive and negative predictive values were 78 and 88%, respectively. Sensitivity was 73% and specificity 91%. In patients with a true-positive CT (n = 24), reintervention followed after a median interval of 0 days (IQR 1), whereas this was 1 day (IQR 2) in the false-negative group (n = 11) (p < 0.05). This was associated with a significantly increased mortality rate (1/24 = 4.2% vs 5/11 = 45.5%) (p < 0.005), an increased length of hospital stay [median 28 days (IQR 26) vs 54 days (IQR 20) (p < 0.05)].

Conclusions

Delayed reintervention after false-negative CT scanning is associated with a high mortality rate and a significant increase in length of hospital stay.
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Metadata
Title
Colorectal anastomotic leak: delay in reintervention after false-negative computed tomography scan is a reason for concern
Authors
C. C. M. Marres
A. W. H. van de Ven
L. G. J. Leijssen
P. C. M. Verbeek
W. A. Bemelman
C. J. Buskens
Publication date
01-09-2017
Publisher
Springer International Publishing
Published in
Techniques in Coloproctology / Issue 9/2017
Print ISSN: 1123-6337
Electronic ISSN: 1128-045X
DOI
https://doi.org/10.1007/s10151-017-1689-6

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