Bowel Anastomotic Leaks: A Pictorial Review of Salient Findings on Computed Tomography (CT)

Authors: Shipra Kumari, Pallavi Rao and Arjun Kalyanpur

Abstract

Background
Anastomotic leaks can occur in early and late post-operative phase when enteric anastomosis fails. Undiagnosed anastomotic leak carries a poor outcome. Therefore, knowledge of accurate interpretation of CT imaging characteristics is vital for a timely and accurate diagnosis of anastomotic leak.

Aims and objectives
The purpose of this study is to assess the salient imaging findings of bowel anastomotic leak on Computed Tomography and compile a pictorial review useful in the identification of anastomotic leaks after gastrointestinal tract surgery.

Materials and Methods
We retrospectively evaluated 49 CT abdomen and pelvis studies which were diagnosed to have post-surgical anastomotic leak as based on keyword search from Emergency Teleradiology reports. Out of 49 cases, non-contrast (17), IV contrast (17), oral contrast (4), oral and IV contrast (10) and rectal contrast (1) were identified. The results were analysed and compiled in a pictorial review.

Results
Our study demonstrated that extraluminal air was the most common imaging finding seen in14.21% of patients. Focal collection or abscess (13.7%), peritonitis in (12.3%), bowel wall thickening (5.4%) and intra-abdominal free fluid (2.9%) of examinations. Few other imaging findings included entero-cutaneous fistula in 2% of the cases and bowel obstruction in one case.Out of 14 examinations performed after administration of enteric contrast, 10 cases were positive for extravasation of intra-luminal contrast.

Conclusion
Early intervention in patients with anastomotic leak has shown to improve