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CT scan for early diagnosis of anastomotic leak after colorectal surgery: is rectal contrast useful?

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Abstract

Background

Computed tomography (CT) scan with rectal contrast enema (RCE-CT) could increase the detection rate of anastomotic leaks (AL) in the early postoperative period following colorectal surgery, compared to CT scan without RCE. The aim of this study was to assess the benefit of RCE-CT for the early diagnosis of AL following colorectal surgery.

Methods

Patients who had a RCE-CT for suspected AL in the early postoperative period following colorectal surgery with anastomosis between January 2012 and July 2019 at the Dijon University Hospital were retrospectively included. All images were reviewed by two independent observers who were blinded to the original report. The reviewers reported for each patient whether an AL was present or not in each imaging modality (CT scan, then RCE-CT). Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were then calculated to determine the diagnostic performance of each modality.

Results

One hundred and thirty-nine patients were included. RCE-CT had an increased NPV compared to CT scan (82% vs 77% (p = 0.02) and 84% vs 68% (p < 0.0001) for observers 1 and 2, respectively). RCE-CT had an increased sensitivity compared to CT scan (79% vs 48% (p < 0.0001) for observer 2). RCE-CT had a significant lower false-negative rate for both observers: 18% vs 23% (p = 0.02) and 16% vs 32% (p < 0.0001).

Conclusions

RCE-CT improved the detection rates of AL in the early period following colorectal surgery. RCE-CT should be recommended when a CT scan is negative and AL is still suspected.

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Author information

Authors and Affiliations

  1. Department of Digestive Surgery, Dijon University Hospital, Dijon, France

    N. Moreno-Lopez, T. Perrin, P. Rat & O. Facy

  2. Department of Radiology, Dijon University Hospital, Dijon, France

    S. Mvouama

  3. Department of Statistics and Clinical Epidemiology, Dijon University Hospital, Dijon, France

    A. Bourredjem & I. Fournel

  4. CIC INSERM 1432, Clinical Epidemiology Unit, University Hospital of Dijon, Dijon, France

    A. Bourredjem & I. Fournel

  5. Department of Digestive Surgery, Lyon University Hospital, Pierre-Bénite, France

    A. Flaris

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  1. N. Moreno-Lopez
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Contributions

M-LN: corresponding author, data collection, and writing. MS: data collection. BA: statistical analysis. FI: statistical analysis. PT: reviewing and editing. FA: reviewing and editing. RP: reviewing and editing. FO: writing, reviewing and editing.

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Correspondence to N. Moreno-Lopez.

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The authors declare that they have no conflict of interest.

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This retrospective study was in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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For this type of study, formal consent is not required (retrospective study with anonymized data).

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Moreno-Lopez, N., Mvouama, S., Bourredjem, A. et al. CT scan for early diagnosis of anastomotic leak after colorectal surgery: is rectal contrast useful?. Tech Coloproctol 27, 639–645 (2023). https://doi.org/10.1007/s10151-022-02716-8

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  • DOI: https://doi.org/10.1007/s10151-022-02716-8

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