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Incidence, risks and outcome of radiological leak following early contrast enema after anterior resection

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Introduction

Anastomotic leak (AL) is a major complication following anterior resection for colorectal cancer. Early contrast enema may diagnose subclinical anastomotic leakage. Knowledge of factors concerning AL is vital to its detection. The aim of this study was to define the incidence, risks and outcome of radiological leak following routine early contrast enema after anterior resection.

Methods

A cohort of 129 patients who underwent anterior resection for colorectal cancer and had an early Gastrografin enema between July 2008 and December 2012 in a tertiary referral centre was identified from a prospective database. The severity of AL was defined using the International Study Group of Rectal Cancer (ISREC) grading system.

Results

Of the 129 patients, 65.1 % were male, and the mean age at surgery was 64.6 ± 1.1 years. Gastrografin enema was performed on average on post-operative day 4.8 ± 0.2. Eighteen patients (14.0 %) had a radiological leak on Gastrografin enema, and nine patients (7.0 %) had a clinical AL. On multivariate analysis, only being of male sex and having a loop ileostomy increased the risk of radiological AL. Gastrografin enema had a sensitivity of 100 % (95 % CI 66–100 %) and specificity of 93 % (95 % CI 86–97 %) for predicting clinical AL. Of the 18 patients with radiological leaks, 11 were ISREC grade A, 3 were grade B and 4 were grade C.

Conclusions

In the current series, early Gastrografin enema following anterior resection identifies a 14 % radiological leak rate and has a high sensitivity and specificity for predicting clinical AL. The majority of radiological leaks may be managed conservatively.

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Acknowledgments

The authors wish to thank Joan Kehoe, Mary Conway, Janette Hanway and Orna Bacon for their integral role in data accrual and the department of radiology for their interpretation of contrast enemata.

Conflict of interest

None to declare

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Authors and Affiliations

  1. Department of Colorectal Surgery, Beaumont Hospital, Dublin 9, Ireland

    Frank Reilly, John P. Burke, Eline Appelmans, Talha Manzoor, Joseph Deasy & Deborah A. McNamara

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  1. Frank Reilly
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  2. John P. Burke
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  3. Eline Appelmans
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  4. Talha Manzoor
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  5. Joseph Deasy
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  6. Deborah A. McNamara
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Correspondence to Deborah A. McNamara.

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Reilly, F., Burke, J.P., Appelmans, E. et al. Incidence, risks and outcome of radiological leak following early contrast enema after anterior resection. Int J Colorectal Dis 29, 453–458 (2014). https://doi.org/10.1007/s00384-013-1820-8

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  • DOI: https://doi.org/10.1007/s00384-013-1820-8

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