Background: 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.
Study design: 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.
Results: 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.
Conclusions: 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.