Type:
Educational Exhibit
Keywords:
Fistula, Diagnostic procedure, Contrast agent-other, Complications, Fluoroscopy, Gastrointestinal tract, Colon, Abdomen
Authors:
G. Tarantini, P. Boraschi, F. Donati, D. Caramella; Pisa/IT
DOI:
10.1594/ecr2018/C-1642
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 diagnose anastomotic leaks early,
which is imperative to decrease the risk of permanent stomas and death [2].
In our hospital we routinely use WCE imaging on all patients who have undergone colorectal surgery with low or ultralow anterior resection of the rectum before stoma restoration,
in order to identify radiological leaks even when the patient is asymptomatic.
In case of a leakage on retrograde WCE,
surgeons generally do not perform stoma restoration; they prefer to wait until the leakage has completely resolved in order to avoid potentially fatal anastomosis-related septic complications [3].
This is why retrograde WCE plays a crucial role in the diagnosis of postoperative radiologic leakages and it has a great impact on morbidity and mortality.