Barium sulfate as contrast medium for evaluation of postoperative anastomotic leaks

To assess the value of barium swallow as a method for immediate re-examination after the failure of an aqueous iodinated agent in detection of clinically suspected postoperative esophageal leakage, and as the initial study in asymptomatic postoperative patients.

Prospective examinations were performed in 114 postoperative patients, 95 males and 19 females (mean age 60 years). Initial esophagography with an aqueous contrast agent was performed in all cases. The patients who had no evidence of leakage underwent immediate re-examination with barium sulfate. Leakage volume was calculated in cm3. Clinical presentations of leakage before the examinations and the complications after the study were recorded.

Leakage was shown with the initial study, using aqueous medium, in 23 patients (20%). The volume of leakage was between 0.05 and 36 cm3 (mean 3.95 cm3). Clinical signs and symptoms presented in 13 cases (56%). Fourteen of 91 patients (15%), who had negative results with the initial study, had evidence of leakage at barium swallow. The leakage volume ranged between 0.06 and 0.53 cm3 (mean 0.18 cm3). Clinical evidence of leakage was shown in 3/14 (21%) cases. No complications were detected over a 6-month period following the study.

A barium swallow should follow a negative study using an aqueous agent in clinically suspected postoperative leakage, and could be considered as a safe initial study in postoperative patients where a leak is not suspected on clinical grounds.