title: Incidence, risks and outcome of radiological leak following early contrast enema after anterior resection.
abstract: BACKGROUND
  Anastomotic leak (AL) is a major complication following anterior resection for colorectal cancer. Early contrast enema may diagnose subclinical anastomotic leakage. Knowledge of factors concerning AL is vital to its detection. The aim of this study was to define the incidence, risks and outcome of radiological leak following routine early contrast enema after anterior resection.
  
  
  METHODS
  A cohort of 129 patients who underwent anterior resection for colorectal cancer and had an early Gastrografin enema between July 2008 and December 2012 in a tertiary referral centre was identified from a prospective database. The severity of AL was defined using the International Study Group of Rectal Cancer (ISREC) grading system.
  
  
  RESULTS
  Of the 129 patients, 65.1 % were male, and the mean age at surgery was 64.6 ± 1.1 years. Gastrografin enema was performed on average on post-operative day 4.8 ± 0.2. Eighteen patients (14.0 %) had a radiological leak on Gastrografin enema, and nine patients (7.0 %) had a clinical AL. On multivariate analysis, only being of male sex and having a loop ileostomy increased the risk of radiological AL. Gastrografin enema had a sensitivity of 100 % (95 % CI 66-100 %) and specificity of 93 % (95 % CI 86-97 %) for predicting clinical AL. Of the 18 patients with radiological leaks, 11 were ISREC grade A, 3 were grade B and 4 were grade C.
  
  
  CONCLUSIONS
  In the current series, early Gastrografin enema following anterior resection identifies a 14 % radiological leak rate and has a high sensitivity and specificity for predicting clinical AL. The majority of radiological leaks may be managed conservatively.
authors.affiliation: Department of Colorectal Surgery, Beaumont Hospital, Dublin 9, Ireland.
authors.forename: Frank
authors.initials: F
authors.lastname: Reilly
authors.forename: John P
authors.initials: JP
authors.lastname: Burke
authors.forename: Eline
authors.initials: E
authors.lastname: Appelmans
authors.forename: Talha
authors.initials: T
authors.lastname: Manzoor
authors.forename: Joseph
authors.initials: J
authors.lastname: Deasy
authors.forename: Deborah A
authors.initials: DA
authors.lastname: McNamara
mesh_terms: D000368:Aged; D057868:Anastomotic Leak / Q000000981:diagnostic imaging* / Q000453:epidemiology; D003110:Colonic Neoplasms / Q000601:surgery*; D003287:Contrast Media; D003974:Diatrizoate Meglumine; D042241:Early Diagnosis; D004733:Enema; D005260:Female; D006801:Humans; D007081:Ileostomy; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011859:Radiography; D012004:Rectal Neoplasms / Q000601:surgery*; D012307:Risk Factors; D012680:Sensitivity and Specificity; D012737:Sex Factors
chemical_list: D003287:Contrast Media; D003974:Diatrizoate Meglumine