title: Clinical and subclinical leaks after low colorectal anastomosis: a clinical and radiologic study.
abstract: OBJECTIVE
  This study was designed to examine the natural history of subclinical leaks and their effect on bowel function and quality of life and to evaluate water-soluble contrast enema features that predict anastomotic healing after leaks.
  
  
  METHODS
  Consecutive patients who underwent low rectal anastomosis were followed up postoperatively for leaks. All leaks were confirmed radiologically with CT scanning and water-soluble contrast enema imaging. Water-soluble contrast enemas were serially repeated to identify healing. Characteristics on initial water-soluble contrast enema were correlated with observed healing. Postoperatively, patients were required to fill in a quality of life and a bowel function questionnaire.
  
  
  RESULTS
  A total of 138 patients underwent low rectal anastomosis procedures with a median follow-up period of 26 (interquartile range, 19-37) months. There were 23 documented leaks of which 13 (9 percent) presented clinically and 10 (8 percent) presented subclinically. Ileostomy closure was possible in 4 of 13 (30 percent) patients with a clinical leak and all 10 (100 percent) patients with a subclinical leak. Median quality of life scores were lower for patients with clinical leaks and no ileostomy closure (P = 0.03). Bowel function for subclinical leak patients and clinical leak patients with ileostomy closure were similarly impaired. The presence of a cavity (P = 0.01) and a stricture (P = 0.01) at the anastomotic site were unfavorable radiologic features associated with nonhealing.
  
  
  CONCLUSIONS
  Subclinical leaks are more benign in their natural history compared with clinical leaks. Quality of life and bowel function is no better in patients with a subclinical leak compared with patients with a clinical leak who have ileostomy closure. Anastomotic leaks may resolve if favorable radiologic features are present.
authors.affiliation: Department of Colorectal Surgery, Leeds General Infirmary, Leeds LS1 3EX, United Kingdom.
authors.forename: Michael
authors.initials: M
authors.lastname: Lim
authors.forename: Saleem
authors.initials: S
authors.lastname: Akhtar
authors.forename: Kishore
authors.initials: K
authors.lastname: Sasapu
authors.forename: Keith
authors.initials: K
authors.lastname: Harris
authors.forename: Dermot
authors.initials: D
authors.lastname: Burke
authors.forename: Peter
authors.initials: P
authors.lastname: Sagar
authors.forename: Paul
authors.initials: P
authors.lastname: Finan
mesh_terms: D000368:Aged; D000714:Anastomosis, Surgical; D003106:Colon / Q000000981:diagnostic imaging / Q000601:surgery*; D003287:Contrast Media / Q000008:administration & dosage; D004733:Enema; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging*; D011788:Quality of Life; D011859:Radiography; D012004:Rectal Neoplasms / Q000601:surgery*; D012007:Rectum / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D011795:Surveys and Questionnaires; D014945:Wound Healing
chemical_list: D003287:Contrast Media