title: CT findings suggesting anastomotic leak and predicting the recovery period following gastric surgery.
abstract: OBJECTIVE
  To assess diagnostic performance of routine CT for detecting anastomotic leak after gastric surgery, and analyse the relationship between recovery period and CT findings.
  
  
  METHODS
  We included 179 patients who underwent immediate CT and fluoroscopy after gastric surgery. Two reviewers retrospectively rated the possibility of leak on CT using a five-point scale focused on predefined CT findings. They also evaluated CT findings. Patients were categorised as: Group I, leak on fluoroscopy; Group II, possible leak on CT but negative on fluoroscopy; Group III, no leak. We analysed the relationship between recovery period and group.
  
  
  RESULTS
  Area under the curve for detecting leak on CT was 0.886 in R1 and 0.668 in R2 with moderate agreement (к = 0.482). Statistically common CT findings for leak included discontinuity, large amount of air-fluid and wall thickening at anastomosis site (p < 0.05). Discontinuity at anastomosis site and a large air-fluid collection were independently associated with leak (p < 0.05). The recovery period including hospitalisation and postoperative fasting period was longer in Group I than Group II or III (p < 0.05). Group II showed a longer recovery period than Group III (p < 0.05).
  
  
  CONCLUSIONS
  Postoperative routine CT was useful for predicting anastomotic leak using specific findings, and for predicting length of recovery period.
  
  
  CONCLUSIONS
  • Anastomotic leakage remains a significant clinical problem following gastric surgery. • Routine CT without oral contrast is useful for predicting anastomotic leaking. • Wall discontinuity at anastomosis sites was an independent predictor for leaking. • CT is also useful for predicting recovery period following gastric surgery.
authors.affiliation: Department of Radiology, Institute of Radiation Medicine, Seoul National University College of Medicine, 01 Daehangno, Jongno-gu, Seoul, 110-744, Republic of Korea.
authors.forename: Tae Ho
authors.initials: TH
authors.lastname: Kim
authors.forename: Jung Hoon
authors.initials: JH
authors.lastname: Kim
authors.forename: Cheong-Il
authors.initials: CI
authors.lastname: Shin
authors.forename: Se Hyung
authors.initials: SH
authors.lastname: Kim
authors.forename: Joon Koo
authors.initials: JK
authors.lastname: Han
authors.forename: Byung Ihn
authors.initials: BI
authors.lastname: Choi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D057868:Anastomotic Leak / Q000000981:diagnostic imaging*; D004385:Duodenostomy / Q000379:methods; D005260:Female; D005471:Fluoroscopy / Q000379:methods; D005743:Gastrectomy / Q000379:methods; D005774:Gastrostomy / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care / Q000379:methods; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D055815:Young Adult