title: Systematic review on the value of CT scanning in the diagnosis of anastomotic leakage after colorectal surgery.
abstract: BACKGROUND
  Timely diagnosis of anastomotic leakage after colorectal surgery and adequate treatment is important to reduce morbidity and mortality. Abdominal computed tomography (CT) scanning is the diagnostic tool of preference, but its value may be questionable in the early postoperative period. The accuracy of CT scanning for the detection of anastomotic leakage and its role in timing of intervention was evaluated.
  
  
  METHODS
  A systematic literature search was performed. Relevant publications were identified from four electronic databases between 1990 and 2011. Inclusion criteria were human studies, studies published in English or Dutch, colorectal surgery with primary anastomosis, and abdominal CT scan with reported outcome for the detection of anastomotic leakage. Exclusion criteria were cohort of fewer than five patients, other gastrointestinal surgery, no anastomosis, and radiological imaging other than CT.
  
  
  RESULTS
  Eight studies, including 221 abdominal CT scans, fulfilled the inclusion criteria. Overall, the methodological quality of the studies was poor. The overall sensitivity of CT scanning to diagnose leakage was 0.68 (95 % confidence interval 0.59-0.75) for colonic resection. Data on the sequelae of false-negative CT scanning was not available.
  
  
  CONCLUSIONS
  There is limited good-quality evidence to determine the value of CT scans in the detection of anastomotic leakage. To prevent delay in diagnosis and appropriate treatment of anastomotic leakage, the relatively low sensitivity of CT scanning must be taken into account.
authors.affiliation: Department of Surgery, St. Antonius Hospital, Koekoekslaan 1, 3435 CM, Nieuwegein, The Netherlands. vnnkornmann@gmail.com
authors.forename: Verena N N
authors.initials: VN
authors.lastname: Kornmann
authors.forename: Nikki
authors.initials: N
authors.lastname: Treskes
authors.forename: Lilian H F
authors.initials: LH
authors.lastname: Hoonhout
authors.forename: Thomas L
authors.initials: TL
authors.lastname: Bollen
authors.forename: Bert
authors.initials: B
authors.lastname: van Ramshorst
authors.forename: Djamila
authors.initials: D
authors.lastname: Boerma
mesh_terms: D057868:Anastomotic Leak / Q000000981:diagnostic imaging* / Q000209:etiology*; D003107:Colorectal Surgery / Q000009:adverse effects*; D005188:False Negative Reactions; D006801:Humans; D011182:Postoperative Care; D011860:Radiography, Abdominal; D014057:Tomography, X-Ray Computed