Abdominal computed tomography for diagnosing postoperative lower gastrointestinal tract leaks

Computed tomography (CT) is the most readily available imaging tool for diagnosis of postoperative lower gastrointestinal tract (LGIT) leak. The accuracy and sensitivity of CT for diagnosing a leak from a hollow viscous or anastomotic bowel leakage are still not well established. This retrospective study was conducted in order to define the role of CT in this setting.

The medical records of patients who underwent early relaparotomy (within 30 days) due to LGIT leak following a previous surgery in our department between 1998 and 2006 were reviewed. The ones whose abdominal CTs were done within 72 h prior to the repeated surgery with the aim of ruling out an intraabdominal infection or leak were studied, and the results were compared to the postsurgical findings.

Seventy patients were reoperated shortly following abdominal surgery due to postoperative LGIT leak. Forty-one of them had undergone 45 CT studies within 72 h before reoperation. Another 29 patients underwent a second procedure based on clinical presentation. Reoperation was done after an interval of 7.3 +/- 4.4 days in patients who underwent CT studies and after 4.5 +/- 2.3 days in patients without CTs (p = 0.003). Preoperative CTs identified only 47% of the leaks.

CT studies on patients shortly after abdominal surgery are not definitive. A negative CT study does not rule out LGIT leak. Clinically based decision making and exploratory relaparotomy still do play a role in those patients with suspicion for LGIT leak.