ISSN: 1859 - 2872
Diagnostic value of computed tomography with rectal contrast administration in detecting colorectal anastomotic leakage after cancer surgery
Main Article Content
Keywords
Computed tomography, rectal contrast, colorectal anastomotic leakage.
Abstract
Objective: To determine the diagnostic value of CT with rectal contrast administration in detecting colorectal anastomotic leakage after surgery for colorectal cancer. Subject and method: A retrospective cross-sectional study was conducted in 80 patients with clinically suspected colorectal anastomotic leakage after cancer surgery, who underwent CT with rectal contrast administration and subsequent reoperation. CT findings were compared with operative findings to evaluate diagnostic performance. Results: The mean age was 58.1 ± 16.2 years, and men accounted for 60.0% of the cohort. The absence of free intraperitoneal air had the highest rule-out value for anastomotic leakage (LR- = 0.10; 95% CI: 0.04 - 0.26). Perianastomotic free air had the highest rule-in value (LR+ = 8.29; 95% CI: 1.29 - 53.36). CT with rectal contrast administration showed a sensitivity of 92.9%, a specificity of 70.0%, a positive predictive value of 95.6%, and a negative predictive value of 58.3% (LR+ = 3.10; LR- = 0.10). Conclusion: CT with rectal contrast administration was a useful modality for diagnosing colorectal anastomotic leakage after cancer surgery, particularly in patients with persistent clinical suspicion. However, a negative CT result did not completely exclude anastomotic leakage and should be interpreted in conjunction with the clinical findings.
Article Details
References
1. Slieker JC, Komen N, Mannaerts GH et al (2012) Long-term and perioperative corticosteroids in anastomotic leakage: A prospective study of 259 left-sided colorectal anastomoses. Arch Surg 147(5): 447-452. doi:10.1001/archsurg.2011.1690
2. Rahbari NN, Weitz J, Hohenberger W et al (2010) Definition and grading of anastomotic leakage following anterior resection of the rectum: a proposal by the International Study Group of Rectal Cancer. Surgery 147(3): 339-351. doi:10.1016/j.surg.2009.10.012
3. Notash AY, Sadeghian E, Moghimi Z, Rahimi Y, Sobhanian E (2025) Diagnostic value of CT scan findings for anastomotic leakage after low anterior resection without ileostomy in rectal cancer. Sci Rep 15(1): 20950. doi:10.1038/s41598-025-06712-4
4. Kornmann VN, Treskes N, Hoonhout LH, Bollen TL, van Ramshorst B, Boerma D (2013) Systematic review on the value of CT scanning in the diagnosis of anastomotic leakage after colorectal surgery. Int J Colorectal Dis 28(4): 437-445. doi:10.1007/s00384-012-1623-3
5. Peters EG, Dekkers M, van Leeuwen-Hilbers FW et al (2017) Relation between postoperative ileus and anastomotic leakage after colorectal resection: A post hoc analysis of a prospective randomized controlled trial. Colorectal Dis 19(7): 667-674. doi:10.1111/codi.13582
6. Dương Đình Hoàn, Võ Tấn Đức, Lê Văn Phước (2022) Describing the features of computed tomography in diagnosing anastomotic leak. Vietnamese Journal of Radiology and Nuclear Medicine 32: 16-21. doi:10.55046/vjrnm.32.533.2018
7. Power N, Atri M, Ryan S, Haddad R, Smith A (2007) CT assessment of anastomotic bowel leak. Clin Radiol 62(1): 37-42. doi:10.1016/j.crad.2006.08.004
8. Gervaz P, Platon A, Buchs NC, Rocher T, Perneger T, Poletti PA (2013) CT scan-based modelling of anastomotic leak risk after colorectal surgery. Colorectal Dis 15(10): 1295-1300. doi:10.1111/codi.12305
9. Tsai YY, Chen WT (2019) Management of anastomotic leakage after rectal surgery: A review article. J Gastrointest Oncol 10(6): 1229-1237. doi:10.21037/jgo.2019.07.07
10. Marres CCM, Engelmann EWM, Buskens CJ, Haak HE, Bemelman WA, van de Ven AWH (2021) The importance of rectal contrast in CT assessment to detect anastomotic leakage after colorectal surgery. Colorectal Dis 23(9): 2466-2471. doi:10.1111/codi.15764
11. Samji KB, Kielar AZ, Connolly M et al (2018) Anastomotic leaks after small- and large-bowel surgery: Diagnostic performance of CT and the importance of intraluminal contrast administration. AJR Am J Roentgenol 210(6): 1259-1265. doi:10.2214/AJR.17.18642
12. Kornmann VN, van Ramshorst B, Smits AB, Bollen TL, Boerma D (2014) Beware of false-negative CT scan for anastomotic leakage after colonic surgery. Int J Colorectal Dis 29(4): 445-451. doi:10.1007/s00384-013-1815-5
13. Gessler B, Eriksson O, Angenete E (2017) Diagnosis, treatment, and consequences of anastomotic leakage in colorectal surgery. Int J Colorectal Dis. 2017;32(4):549-556. doi:10.1007/s00384-016-2744-x
14. Moreno-Lopez N, Mvouama S, Bourredjem A, et al (2023) CT scan for early diagnosis of anastomotic leak after colorectal surgery: Is rectal contrast useful? Tech Coloproctol 27(8): 639-645. doi:10.1007/s10151-022-02716-8
1. Slieker JC, Komen N, Mannaerts GH et al (2012) Long-term and perioperative corticosteroids in anastomotic leakage: A prospective study of 259 left-sided colorectal anastomoses. Arch Surg 147(5): 447-452. doi:10.1001/archsurg.2011.1690
2. Rahbari NN, Weitz J, Hohenberger W et al (2010) Definition and grading of anastomotic leakage following anterior resection of the rectum: a proposal by the International Study Group of Rectal Cancer. Surgery 147(3): 339-351. doi:10.1016/j.surg.2009.10.012
3. Notash AY, Sadeghian E, Moghimi Z, Rahimi Y, Sobhanian E (2025) Diagnostic value of CT scan findings for anastomotic leakage after low anterior resection without ileostomy in rectal cancer. Sci Rep 15(1): 20950. doi:10.1038/s41598-025-06712-4
4. Kornmann VN, Treskes N, Hoonhout LH, Bollen TL, van Ramshorst B, Boerma D (2013) Systematic review on the value of CT scanning in the diagnosis of anastomotic leakage after colorectal surgery. Int J Colorectal Dis 28(4): 437-445. doi:10.1007/s00384-012-1623-3
5. Peters EG, Dekkers M, van Leeuwen-Hilbers FW et al (2017) Relation between postoperative ileus and anastomotic leakage after colorectal resection: A post hoc analysis of a prospective randomized controlled trial. Colorectal Dis 19(7): 667-674. doi:10.1111/codi.13582
6. Dương Đình Hoàn, Võ Tấn Đức, Lê Văn Phước (2022) Describing the features of computed tomography in diagnosing anastomotic leak. Vietnamese Journal of Radiology and Nuclear Medicine 32: 16-21. doi:10.55046/vjrnm.32.533.2018
7. Power N, Atri M, Ryan S, Haddad R, Smith A (2007) CT assessment of anastomotic bowel leak. Clin Radiol 62(1): 37-42. doi:10.1016/j.crad.2006.08.004
8. Gervaz P, Platon A, Buchs NC, Rocher T, Perneger T, Poletti PA (2013) CT scan-based modelling of anastomotic leak risk after colorectal surgery. Colorectal Dis 15(10): 1295-1300. doi:10.1111/codi.12305
9. Tsai YY, Chen WT (2019) Management of anastomotic leakage after rectal surgery: A review article. J Gastrointest Oncol 10(6): 1229-1237. doi:10.21037/jgo.2019.07.07
10. Marres CCM, Engelmann EWM, Buskens CJ, Haak HE, Bemelman WA, van de Ven AWH (2021) The importance of rectal contrast in CT assessment to detect anastomotic leakage after colorectal surgery. Colorectal Dis 23(9): 2466-2471. doi:10.1111/codi.15764
11. Samji KB, Kielar AZ, Connolly M et al (2018) Anastomotic leaks after small- and large-bowel surgery: Diagnostic performance of CT and the importance of intraluminal contrast administration. AJR Am J Roentgenol 210(6): 1259-1265. doi:10.2214/AJR.17.18642
12. Kornmann VN, van Ramshorst B, Smits AB, Bollen TL, Boerma D (2014) Beware of false-negative CT scan for anastomotic leakage after colonic surgery. Int J Colorectal Dis 29(4): 445-451. doi:10.1007/s00384-013-1815-5
13. Gessler B, Eriksson O, Angenete E (2017) Diagnosis, treatment, and consequences of anastomotic leakage in colorectal surgery. Int J Colorectal Dis. 2017;32(4):549-556. doi:10.1007/s00384-016-2744-x
14. Moreno-Lopez N, Mvouama S, Bourredjem A, et al (2023) CT scan for early diagnosis of anastomotic leak after colorectal surgery: Is rectal contrast useful? Tech Coloproctol 27(8): 639-645. doi:10.1007/s10151-022-02716-8
2. Rahbari NN, Weitz J, Hohenberger W et al (2010) Definition and grading of anastomotic leakage following anterior resection of the rectum: a proposal by the International Study Group of Rectal Cancer. Surgery 147(3): 339-351. doi:10.1016/j.surg.2009.10.012
3. Notash AY, Sadeghian E, Moghimi Z, Rahimi Y, Sobhanian E (2025) Diagnostic value of CT scan findings for anastomotic leakage after low anterior resection without ileostomy in rectal cancer. Sci Rep 15(1): 20950. doi:10.1038/s41598-025-06712-4
4. Kornmann VN, Treskes N, Hoonhout LH, Bollen TL, van Ramshorst B, Boerma D (2013) Systematic review on the value of CT scanning in the diagnosis of anastomotic leakage after colorectal surgery. Int J Colorectal Dis 28(4): 437-445. doi:10.1007/s00384-012-1623-3
5. Peters EG, Dekkers M, van Leeuwen-Hilbers FW et al (2017) Relation between postoperative ileus and anastomotic leakage after colorectal resection: A post hoc analysis of a prospective randomized controlled trial. Colorectal Dis 19(7): 667-674. doi:10.1111/codi.13582
6. Dương Đình Hoàn, Võ Tấn Đức, Lê Văn Phước (2022) Describing the features of computed tomography in diagnosing anastomotic leak. Vietnamese Journal of Radiology and Nuclear Medicine 32: 16-21. doi:10.55046/vjrnm.32.533.2018
7. Power N, Atri M, Ryan S, Haddad R, Smith A (2007) CT assessment of anastomotic bowel leak. Clin Radiol 62(1): 37-42. doi:10.1016/j.crad.2006.08.004
8. Gervaz P, Platon A, Buchs NC, Rocher T, Perneger T, Poletti PA (2013) CT scan-based modelling of anastomotic leak risk after colorectal surgery. Colorectal Dis 15(10): 1295-1300. doi:10.1111/codi.12305
9. Tsai YY, Chen WT (2019) Management of anastomotic leakage after rectal surgery: A review article. J Gastrointest Oncol 10(6): 1229-1237. doi:10.21037/jgo.2019.07.07
10. Marres CCM, Engelmann EWM, Buskens CJ, Haak HE, Bemelman WA, van de Ven AWH (2021) The importance of rectal contrast in CT assessment to detect anastomotic leakage after colorectal surgery. Colorectal Dis 23(9): 2466-2471. doi:10.1111/codi.15764
11. Samji KB, Kielar AZ, Connolly M et al (2018) Anastomotic leaks after small- and large-bowel surgery: Diagnostic performance of CT and the importance of intraluminal contrast administration. AJR Am J Roentgenol 210(6): 1259-1265. doi:10.2214/AJR.17.18642
12. Kornmann VN, van Ramshorst B, Smits AB, Bollen TL, Boerma D (2014) Beware of false-negative CT scan for anastomotic leakage after colonic surgery. Int J Colorectal Dis 29(4): 445-451. doi:10.1007/s00384-013-1815-5
13. Gessler B, Eriksson O, Angenete E (2017) Diagnosis, treatment, and consequences of anastomotic leakage in colorectal surgery. Int J Colorectal Dis. 2017;32(4):549-556. doi:10.1007/s00384-016-2744-x
14. Moreno-Lopez N, Mvouama S, Bourredjem A, et al (2023) CT scan for early diagnosis of anastomotic leak after colorectal surgery: Is rectal contrast useful? Tech Coloproctol 27(8): 639-645. doi:10.1007/s10151-022-02716-8
1. Slieker JC, Komen N, Mannaerts GH et al (2012) Long-term and perioperative corticosteroids in anastomotic leakage: A prospective study of 259 left-sided colorectal anastomoses. Arch Surg 147(5): 447-452. doi:10.1001/archsurg.2011.1690
2. Rahbari NN, Weitz J, Hohenberger W et al (2010) Definition and grading of anastomotic leakage following anterior resection of the rectum: a proposal by the International Study Group of Rectal Cancer. Surgery 147(3): 339-351. doi:10.1016/j.surg.2009.10.012
3. Notash AY, Sadeghian E, Moghimi Z, Rahimi Y, Sobhanian E (2025) Diagnostic value of CT scan findings for anastomotic leakage after low anterior resection without ileostomy in rectal cancer. Sci Rep 15(1): 20950. doi:10.1038/s41598-025-06712-4
4. Kornmann VN, Treskes N, Hoonhout LH, Bollen TL, van Ramshorst B, Boerma D (2013) Systematic review on the value of CT scanning in the diagnosis of anastomotic leakage after colorectal surgery. Int J Colorectal Dis 28(4): 437-445. doi:10.1007/s00384-012-1623-3
5. Peters EG, Dekkers M, van Leeuwen-Hilbers FW et al (2017) Relation between postoperative ileus and anastomotic leakage after colorectal resection: A post hoc analysis of a prospective randomized controlled trial. Colorectal Dis 19(7): 667-674. doi:10.1111/codi.13582
6. Dương Đình Hoàn, Võ Tấn Đức, Lê Văn Phước (2022) Describing the features of computed tomography in diagnosing anastomotic leak. Vietnamese Journal of Radiology and Nuclear Medicine 32: 16-21. doi:10.55046/vjrnm.32.533.2018
7. Power N, Atri M, Ryan S, Haddad R, Smith A (2007) CT assessment of anastomotic bowel leak. Clin Radiol 62(1): 37-42. doi:10.1016/j.crad.2006.08.004
8. Gervaz P, Platon A, Buchs NC, Rocher T, Perneger T, Poletti PA (2013) CT scan-based modelling of anastomotic leak risk after colorectal surgery. Colorectal Dis 15(10): 1295-1300. doi:10.1111/codi.12305
9. Tsai YY, Chen WT (2019) Management of anastomotic leakage after rectal surgery: A review article. J Gastrointest Oncol 10(6): 1229-1237. doi:10.21037/jgo.2019.07.07
10. Marres CCM, Engelmann EWM, Buskens CJ, Haak HE, Bemelman WA, van de Ven AWH (2021) The importance of rectal contrast in CT assessment to detect anastomotic leakage after colorectal surgery. Colorectal Dis 23(9): 2466-2471. doi:10.1111/codi.15764
11. Samji KB, Kielar AZ, Connolly M et al (2018) Anastomotic leaks after small- and large-bowel surgery: Diagnostic performance of CT and the importance of intraluminal contrast administration. AJR Am J Roentgenol 210(6): 1259-1265. doi:10.2214/AJR.17.18642
12. Kornmann VN, van Ramshorst B, Smits AB, Bollen TL, Boerma D (2014) Beware of false-negative CT scan for anastomotic leakage after colonic surgery. Int J Colorectal Dis 29(4): 445-451. doi:10.1007/s00384-013-1815-5
13. Gessler B, Eriksson O, Angenete E (2017) Diagnosis, treatment, and consequences of anastomotic leakage in colorectal surgery. Int J Colorectal Dis. 2017;32(4):549-556. doi:10.1007/s00384-016-2744-x
14. Moreno-Lopez N, Mvouama S, Bourredjem A, et al (2023) CT scan for early diagnosis of anastomotic leak after colorectal surgery: Is rectal contrast useful? Tech Coloproctol 27(8): 639-645. doi:10.1007/s10151-022-02716-8
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Published
Jul 7, 2026
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How to Cite
LiêmP. T., & TuấnH. X. (2026). Diagnostic value of computed tomography with rectal contrast administration in detecting colorectal anastomotic leakage after cancer surgery . Tạp Chí Y Dược lâm sàng 108, 21(6). https://doi.org/10.52389/ydls.v21i6.3103