Learning objectives
Illustrate the spectrum of imaging findings of morphological types of radiologic leakages on retrograde water-soluble enema (WCE) in patients with colorectal surgical anastomosis
Give tips and tools to enable identification of radiological leakages on retrograde WCE in patients who have undergone colorectal surgery,
particularly of the smallest leaks which can be easily missed
Background
Postoperative anastomotic leaks after colorectal surgery can have severe consequences for patients,
particularly ones who present with few or no symptoms.
For patients who have undergone colorectal surgery,
anastomotic leaks are a serious and challenging complication which may occur in up to 51% of cases [1].
Clinical signs and symptoms (fever,
adynamic ileus,
leukocytosis,
increased fluid collection through abdominal drains) typically become apparent postoperatively between days 5 and 8,
although some patients can remain asymptomatic.
WCE imaging provides a non-invasive,
effective tool to identify and...
Findings and procedure details
Retrograde WCE is performed with water soluble-contrast introduced in the rectum by a Foley catheter.
The radiologist takes images at different angles inviting the patient to change position during the exam and evaluate the colorectal anastomosis through 360 degrees minimizing the risk of not identifying the radiological leakages.
A positive retrograde WCE study is defined by the presence of contrast outside the bowel lumen or peri-anastomotic fluid collections or a fistula.
Anastomotic leakages are clinically identified with the use of bothclinical examination and laboratory findings....
Conclusion
A retrograde WCE study is fundamental in detecting radiologic leakages before reversal of a diverting stoma.
Therefore,
it is mandatory for the radiologist to identify even the smallest anastomotic leaks.
This collection of images aims to help radiologists performing retrograde WCE study to identify the leakage and its type,
as the morphology of the leakage might correlate with future surgical intervention or conservative approach.
The knowledge of the imaging features of small leakages may provide radiologists withincreased confidencein the diagnosis of these post-surgical complications.
Personal information
Gaia Tarantini,
MD
Diagnostic and Interventional Radiology - University of Pisa
Via Paradisa 2,
56124 Pisa,
Italy
Phone: +39-050-995551; Mobile phone: +39-3467764120
E-mail:
[email protected]
Piero Boraschi,
MD
Department of Diagnostic Imaging - Pisa University Hospital
Via Paradisa 2,
56124 Pisa,
Italy
Phone: +39-050-996782; Mobile phone: +39-3385054954
E-mail:
[email protected]
Francescamaria Donati,
MD
Department of Diagnostic Imaging - Pisa University Hospital
Via Paradisa 2,
56124 Pisa,
Italy
Phone: +39-050-996782; Mobile phone: +39-3343214406
E-mail:
[email protected]
Prof.
Davide Caramella,
MD
Diagnostic and Interventional Radiology - University of Pisa
Via...
References
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A.,
Dring R.V.,
Johnson K.H.,
Sardella W.V.,
Vignati P.V.,
Cohen J.L.
Anastomotic Leaks: What is the Best Diagnostic Imaging Study? Dis Colon rectum.
2007 Feb;50(2):197-203.
[2] Daams F.,
Luyer M.,
Lange J.
F.
Colorectal anastomotic leakage: Aspects of prevention,
detection and treatment.
World J Gastroenterol.
2013 Apr 21;19(15):2293-7.
[3] Seo S.I.,
Lee J.L.,
Park S.H.,
Ha H.K.,
Kim J.C.
Assessment by Using a Water-Soluble Contrast Enema Study of Radiologic Leakage in Lower Rectal Cancer Patients With Sphincter-Saving Surgery.
Ann Coloproctol.
2015 Aug;31(4):131-7....