A 70-year-old female patient underwent anterior resection with primary anastomosis five days ago. Postoperatively, she is suspected to have an anastomotic leak due to signs of sepsis, abdominal pain, and fever. The attending surgeon decides to perform a diagnostic investigation to confirm the presence of an anastomotic leak.
Which of the following is the most suitable diagnostic investigation to confirm an anastomotic leak?
A. Barium enema
B. Abdominal CT scan
C. Water-soluble contrast enema
D. Abdominal CT scan with contrast
The correct answer is D. Abdominal CT scan with contrast.
Explanation:
An anastomotic leak is a serious postoperative complication that requires prompt diagnosis and management. The most suitable investigation should provide clear imaging to confirm the presence of a leak and any associated complications such as abscess formation or peritonitis. Here’s why an abdominal CT scan with contrast is the best choice:
1. Abdominal CT scan with contrast (D):
– A CT scan with contrast is highly sensitive and specific for detecting anastomotic leaks.
– It can visualize the anastomotic site directly and reveal any extraluminal contrast, which indicates a leak.
– Additionally, it can identify other complications such as abscesses, free air, and fluid collections in the abdomen.
– Contrast-enhanced CT provides a detailed assessment of the abdominal cavity, helping to guide further management.
2. Other Options:
– Barium enema (A): Barium enema is generally not recommended in the acute postoperative setting due to the risk of barium-induced peritonitis if there is a leak.
– Abdominal CT scan (B): A non-contrast CT scan is less effective at identifying leaks compared to a contrast-enhanced CT scan. The contrast medium helps to better delineate the structures and identify the presence of a leak.
– Water-soluble contrast enema (C): While a water-soluble contrast enema can be used, it is less comprehensive compared to a CT scan with contrast. It might be used in certain settings but does not provide as much information about the abdominal cavity and associated complications.
Therefore, the most suitable diagnostic investigation to confirm an anastomotic leak in this postoperative patient is D. Abdominal CT scan with contrast. This choice ensures a thorough evaluation and helps in planning the appropriate management for the patient.