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CT findings suggesting anastomotic leak and predicting the recovery period following gastric surgery

  • Gastrointestinal
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To assess diagnostic performance of routine CT for detecting anastomotic leak after gastric surgery, and analyse the relationship between recovery period and CT findings.


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.


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).


Postoperative routine CT was useful for predicting anastomotic leak using specific findings, and for predicting length of recovery period.

Key Points

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.

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The scientific guarantor of this publication is Joon Koo Han, M.D. The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. Tae Ho Kim, M.D. has significant statistical expertise and no complex statistical methods were necessary for this paper. Institutional Review Board approval was obtained (IRB No. 1311-110-539). Written informed consent was waived by the Institutional Review Board because this is a retrospective study using CT and fluoroscopic images. No study subjects or cohorts have been previously reported. Methodology: retrospective, diagnostic study, performed at one institution.

Our abstract was presented at ECR 2014 with the title “A comparison study with fluoroscopy: Can routine CT scan predict anastomotic leaks after gastric surgery?” This abstract was published in Insights into Imaging March 2014, Volume 5, Issue 1 Supplement, pp. 135–368.

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Correspondence to Jung Hoon Kim.

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Kim, T.H., Kim, J.H., Shin, CI. et al. CT findings suggesting anastomotic leak and predicting the recovery period following gastric surgery. Eur Radiol 25, 1958–1966 (2015).

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