Anastomotic leakage after colorectal surgery: diagnostic accuracy of CT.
OBJECTIVE
To evaluate the diagnostic accuracy of CT in postoperative colorectal anastomotic leakage (AL).


METHODS
Two independent blinded radiologists reviewed 153 CTs performed for suspected AL within 60 days after surgery in 131 consecutive patients, with (n = 58) or without (n = 95) retrograde contrast enema (RCE). Results were compared to original interpretations. The reference standard was reoperation or consensus (a radiologist and a surgeon) regarding clinical, laboratory, radiological, and follow-up data after medical treatment.


RESULTS
AL was confirmed in 34/131 patients. For the two reviewers and original interpretation, sensitivity of CT was 82 %, 87 %, and 71 %, respectively; specificity was 84 %, 84 %, and 92 %. RCE significantly increased the positive predictive value (from 40 % to 88 %, P = 0.0009; 41 % to 92 %, P = 0.0016; and 40 % to 100 %, P = 0.0006). Contrast extravasation was the most sensitive (reviewers, 83 % and 83 %) and specific (97 % and 97 %) sign and was significantly associated with AL by univariate analysis (P < 0.0001 and P < 0.0001). By multivariate analysis with recursive partitioning, CT with RCE was accurate to confirm or rule out AL with contrast extravasation.


CONCLUSIONS
CT with RCE is accurate for diagnosing postoperative colorectal AL. Contrast extravasation is the most reliable sign. RCE should be performed during CT for suspected AL.


CONCLUSIONS
• CT accurately diagnosed clinically suspected colorectal AL and showed good interobserver agreement • Contrast extravasation was the most sensitive and specific CT sign • Retrograde contrast enema during CT improved positive predictive value • Retrograde contrast enema decreased false-negative or indeterminate original CT interpretations.
Department of Radiology, Fondation Hôpital Saint-Joseph, 185 rue Raymond Losserand, 75014, Paris, France.
Paul
P
Kauv
Department of Radiology, Fondation Hôpital Saint-Joseph, 185 rue Raymond Losserand, 75014, Paris, France.
Samir
S
Benadjaoud
Laboratoire de biomathématiques, Faculté de pharmacie, Université Paris Descartes, Sorbonne Paris Cité, 4 avenue de l'Observatoire, 75006, Paris, France.
Emmanuel
E
Curis
Department of Radiology, Fondation Hôpital Saint-Joseph, 185 rue Raymond Losserand, 75014, Paris, France.
Isabelle
I
Boulay-Coletta
Department of Digestive Surgery, Fondation Hôpital Saint-Joseph, 185 rue Raymond Losserand, 75014, Paris, France.
Jerome
J
Loriau
Department of Radiology, Fondation Hôpital Saint-Joseph, 185 rue Raymond Losserand, 75014, Paris, France. mzins@hpsj.fr.
Marc
M
Zins
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D057868:Anastomotic Leak / Q000000981:diagnostic imaging*; D003107:Colorectal Surgery / Q000009:adverse effects*; D003287:Contrast Media; D003974:Diatrizoate Meglumine; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011184:Postoperative Period; D011856:Radiographic Image Enhancement; D012086:Reoperation; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed; D014283:Triiodobenzoic Acids; D055815:Young Adult
D003287:Contrast Media; D014283:Triiodobenzoic Acids; D003974:Diatrizoate Meglumine; C054871:ioversol
Anastomotic Leak; Colorectal Surgery; Computed Tomography; Enema; Extravasation of Contrast Media