Amsterdam University Medical Centers, Department of Surgery, Amsterdam, the Netherlands; Cancer Center Amsterdam, Amsterdam, the Netherlands.
Amsterdam University Medical Centers, Department of Surgery, Amsterdam, the Netherlands; Cancer Center Amsterdam, Amsterdam, the Netherlands.
Best Pract Res Clin Gastroenterol. 2024 Jun;70:101925. doi: 10.1016/j.bpg.2024.101925. Epub 2024 Jun 7.
Colorectal anastomotic leakage (CAL) remains a feared complication after colorectal surgery and requires prompt detection and proper treatment. With the upswing of fast-track recovery programs in recent years this challenge has increased, as clinical features may only arise after discharge. Therefore, identification of the best diagnostic tools is of utmost importance, also since early treatment is associated with high success rates. Diagnostic tools range from general screening tools to invasive procedures to assess the severity of the leak. Laboratory tests, in particular the inflammation biomarkers C-reactive protein and procalcitonin, have a significant role in the detection of CAL after colorectal surgery. As these biomarkers are unspecific for CAL, additional imaging should be performed when blood levels are elevated. The golden standard for the detection of AL after colonic resections is a computed tomography (CT-scan). If tolerated, a contrast medium should be administered rectally to enhance diagnostic accuracy. When suspicion of CAL remains high despite negative previous tests, further endoscopy examination should be conducted. However, endoscopic examinations become more suitable for the early diagnostic work-up after rectal resections. This review aims to provide an overview of current diagnostics for the screening and assessment of the severity of CAL after colorectal surgery.
结直肠吻合口漏（CAL）仍然是结直肠手术后令人恐惧的并发症，需要及时发现和正确治疗。近年来，快速康复计划的兴起增加了这一挑战，因为临床特征可能仅在出院后出现。因此，确定最佳诊断工具至关重要，因为早期治疗与高成功率相关。诊断工具范围从一般筛查工具到评估漏液严重程度的侵入性程序。实验室检查，特别是炎症生物标志物 C 反应蛋白和降钙素原，在结直肠手术后 CAL 的检测中具有重要作用。由于这些生物标志物对 CAL 不具有特异性，因此当血液水平升高时应进行额外的影像学检查。检测结肠切除术后 AL 的金标准是计算机断层扫描（CT 扫描）。如果可以耐受，应直肠内给予造影剂以提高诊断准确性。尽管先前的检查结果为阴性，但如果仍高度怀疑 CAL，则应进行进一步的内镜检查。然而，内镜检查对于直肠切除术后的早期诊断更适用。本文旨在提供结直肠手术后 CAL 的筛查和严重程度评估的当前诊断方法概述。
