BACKGROUND: Computed tomography (CT) is the most readily available imaging tool for diagnosis of postoperative lower gastrointestinal tract (LGIT) leak. The accuracy and sensitivity of CT for diagnosing a leak from a hollow viscous or anastomotic bowel leakage are still not well established. This retrospective study was conducted in order to define the role of CT in this setting. STUDY DESIGN: The medical records of patients who underwent early relaparotomy (within 30 days) due to LGIT leak following a previous surgery in our department between 1998 and 2006 were reviewed. The ones whose abdominal CTs were done within 72 h prior to the repeated surgery with the aim of ruling out an intraabdominal infection or leak were studied, and the results were compared to the postsurgical findings. RESULTS: Seventy patients were reoperated shortly following abdominal surgery due to postoperative LGIT leak. Forty-one of them had undergone 45 CT studies within 72 h before reoperation. Another 29 patients underwent a second procedure based on clinical presentation. Reoperation was done after an interval of 7.3 +/- 4.4 days in patients who underwent CT studies and after 4.5 +/- 2.3 days in patients without CTs (p = 0.003). Preoperative CTs identified only 47% of the leaks. CONCLUSIONS: CT studies on patients shortly after abdominal surgery are not definitive. A negative CT study does not rule out LGIT leak. Clinically based decision making and exploratory relaparotomy still do play a role in those patients with suspicion for LGIT leak.
BACKGROUND: Computed tomography (CT) is the most readily available imaging tool for diagnosis of postoperative lower gastrointestinal tract (LGIT) leak. The accuracy and sensitivity of CT for diagnosing a leak from a hollow viscous or anastomotic bowel leakage are still not well established. This retrospective study was conducted in order to define the role of CT in this setting. STUDY DESIGN: The medical records of patients who underwent early relaparotomy (within 30 days) due to LGIT leak following a previous surgery in our department between 1998 and 2006 were reviewed. The ones whose abdominal CTs were done within 72 h prior to the repeated surgery with the aim of ruling out an intraabdominal infection or leak were studied, and the results were compared to the postsurgical findings. RESULTS: Seventy patients were reoperated shortly following abdominal surgery due to postoperative LGIT leak. Forty-one of them had undergone 45 CT studies within 72 h before reoperation. Another 29 patients underwent a second procedure based on clinical presentation. Reoperation was done after an interval of 7.3 +/- 4.4 days in patients who underwent CT studies and after 4.5 +/- 2.3 days in patients without CTs (p = 0.003). Preoperative CTs identified only 47% of the leaks. CONCLUSIONS: CT studies on patients shortly after abdominal surgery are not definitive. A negative CT study does not rule out LGIT leak. Clinically based decision making and exploratory relaparotomy still do play a role in those patients with suspicion for LGIT leak.
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Authors: Verena N N Kornmann; Nikki Treskes; Lilian H F Hoonhout; Thomas L Bollen; Bert van Ramshorst; Djamila Boerma Journal: Int J Colorectal Dis Date: 2012-12-14 Impact factor: 2.571