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Anastomotic leakage after colorectal surgery: diagnostic accuracy of CT

  • Gastrointestinal
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Abstract

Objectives

To evaluate the diagnostic accuracy of CT in postoperative colorectal anastomotic leakage (AL).

Methods

Two independent blinded radiologists reviewed 153 CTs performed for suspected AL within 60 days after surgery in 131 consecutive patients, with (n = 58) or without (n = 95) retrograde contrast enema (RCE). Results were compared to original interpretations. The reference standard was reoperation or consensus (a radiologist and a surgeon) regarding clinical, laboratory, radiological, and follow-up data after medical treatment.

Results

AL was confirmed in 34/131 patients. For the two reviewers and original interpretation, sensitivity of CT was 82 %, 87 %, and 71 %, respectively; specificity was 84 %, 84 %, and 92 %. RCE significantly increased the positive predictive value (from 40 % to 88 %, P = 0.0009; 41 % to 92 %, P = 0.0016; and 40 % to 100 %, P = 0.0006). Contrast extravasation was the most sensitive (reviewers, 83 % and 83 %) and specific (97 % and 97 %) sign and was significantly associated with AL by univariate analysis (P < 0.0001 and P < 0.0001).

By multivariate analysis with recursive partitioning, CT with RCE was accurate to confirm or rule out AL with contrast extravasation.

Conclusions

CT with RCE is accurate for diagnosing postoperative colorectal AL. Contrast extravasation is the most reliable sign. RCE should be performed during CT for suspected AL.

Key Points

• CT accurately diagnosed clinically suspected colorectal AL and showed good interobserver agreement

• Contrast extravasation was the most sensitive and specific CT sign

• Retrograde contrast enema during CT improved positive predictive value

• Retrograde contrast enema decreased false-negative or indeterminate original CT interpretations

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Abbreviations

AL:

Anastomotic leakage

RCE:

Retrograde contrast enema

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Acknowledgments

The scientific guarantor of this publication is Marc Zins. The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. One of the authors has significant statistical expertise. Institutional Review Board approval was obtained. Written informed consent was waived by the Institutional Review Board. Methodology: retrospective, diagnostic study, performed at one institution.

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Authors and Affiliations

  1. Department of Radiology, Fondation Hôpital Saint-Joseph, 185 rue Raymond Losserand, 75014, Paris, France

    Paul Kauv, Samir Benadjaoud, Isabelle Boulay-Coletta & Marc Zins

  2. Laboratoire de biomathématiques, Faculté de pharmacie, Université Paris Descartes, Sorbonne Paris Cité, 4 avenue de l’Observatoire, 75006, Paris, France

    Emmanuel Curis

  3. Department of Digestive Surgery, Fondation Hôpital Saint-Joseph, 185 rue Raymond Losserand, 75014, Paris, France

    Jerome Loriau

Authors
  1. Paul Kauv
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  2. Samir Benadjaoud
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  3. Emmanuel Curis
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  4. Isabelle Boulay-Coletta
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  5. Jerome Loriau
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  6. Marc Zins
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Correspondence to Marc Zins.

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Kauv, P., Benadjaoud, S., Curis, E. et al. Anastomotic leakage after colorectal surgery: diagnostic accuracy of CT. Eur Radiol 25, 3543–3551 (2015). https://doi.org/10.1007/s00330-015-3795-z

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  • DOI: https://doi.org/10.1007/s00330-015-3795-z

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