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Diagnostic Features of McDermott et al for an Intestinal Anastomotic Leak

Description

McDermott et al listed diagnostic features for an anastomotic leak following colorectal surgery. A delay in the diagnosis of an anastomotic leak can result in a worse outcome. The authors are from St. Vincent's University Hospital, Ninewells Hospital (Dundee) and Salford Royal Hospitals NHS Foundation Trust.


The patient may show few signs or symptoms, or the findings may be ambiguous, so a high index of suspicion is necessary.

 

Clues to the diagnosis:

(1) CT scan with or without water-soluble contrast enema

(2) serum C-reactive protein > 150 mg/L on postoperative day 3 to 5

(3) elevated serum procalcitonin on postoperative day 3 to 5

 

The CT scan be negative if performed early. In theory a PET scan may be a sensitive way to detect a leak missed on CT scan.


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