Department of Diagnostic and Interventional Radiology, and Nuclear Medicine, Pisa University Hospital, Via Paradisa 2, 56124, Pisa, Italy.
Department of Radiology, University of Naples "Federico II", Via Pansini 5, 80131, Naples, Italy.
Jpn J Radiol. 2022 Dec;40(12):1235-1240. doi: 10.1007/s11604-022-01348-0. Epub 2022 Oct 19.
For patients who have undergone colorectal surgery, anastomotic leakage is a serious and challenging complication with a variable rate ranging between 1.8% and 19.2%. Postoperative anastomotic leaks after colorectal surgery can have severe consequences for patients, particularly ones who present with few or no symptoms. Computed tomography and/or water-soluble contrast enema (WSE) are the most frequently utilized imaging methods to identify and diagnose anastomotic leaks early. WSE is a safe and complication-free procedure that allows to identify the presence of otherwise unrecognized anastomotic leaks, both in asymptomatic and symptomatic patients. Fluoroscopic rectal examination using a water-soluble contrast agent for postoperative patients is never an easy examination to perform since it requires careful preparation, skill, and knowledge. Four morphological types of anastomotic dispersion have been described: "saccular type", "horny type", "serpentine type" and "dendritic type". Among 4 types of leakage, dendritic and serpentine types are more frequently followed by clinical symptoms and none of the dendritic type resolves spontaneously. On the other hand, the saccular and horny types have a better prognosis after healing of the loss and subsequent restoration of the ostomy as they consist of a cavity that provides a sort of physical barrier to the spread of inflammation. The aim of this pictorial essay was to illustrate the spectrum of imaging findings of morphological types of radiologic leakages on WCE in patients with colorectal surgical anastomosis. We have also tried to provide tips and tools to enable identification of radiological leakages on retrograde WCE, particularly of the smallest leaks which can be more easily missed.
对于接受结直肠手术的患者，吻合口漏是一种严重且具有挑战性的并发症，其发生率在 1.8%至 19.2%之间。结直肠手术后的吻合口漏会给患者带来严重后果，尤其是那些症状不明显或无症状的患者。计算机断层扫描和/或水溶性对比灌肠（WSE）是最常使用的影像学方法，可早期识别和诊断吻合口漏。WSE 是一种安全且无并发症的程序，可识别无症状和有症状患者中隐匿的吻合口漏。对于术后患者，使用水溶性造影剂进行荧光直肠检查绝非易事，因为它需要仔细准备、技巧和知识。已经描述了四种形态类型的吻合口弥散：“囊袋型”、“角质型”、“蛇形型”和“树枝型”。在 4 种类型的漏液中，树枝型和蛇形型更常伴有临床症状，且没有一种树枝型漏液会自发缓解。另一方面，囊袋型和角质型在瘘口愈合后，随后进行造口修复，其预后较好，因为它们由一个腔隙组成，为炎症的扩散提供了一种物理屏障。本文旨在说明 WSE 对结直肠外科吻合口的形态学类型的影像学漏液的影像学表现谱。我们还尝试提供了一些技巧和工具，以帮助识别逆行 WSE 上的影像学漏液，特别是更容易漏诊的最小漏液。
