Presentation
Abdominal pain and fever one week following discharge after a right hemicolectomy for a hepatic flexure tumor.
Patient Data
Right hemicolectomy.
Large gas-air filled collection extending from the site of the presumed anastomosis (hepatic flexure) down into the right iliac fossa - bulk dimensions 9 x 7 cm. This is contiguous with the site of the anastomosis.
Additional 6.8 cm air-filled collection in the right anterior abdominal wall.
Gallstones.
The surgical notes from a laparatomy performed within hours of the CT study.
Correlation with the CT findings.
Case Discussion
Anastomotic leaks are not uncommonly identified post surgery - many are small and do not require additional surgery. Complete anastomotic breakdown (dehiscence) is rare, especially in the elective setting.
This case is dramatic in that the transverse colon continues straight from a large collection of gas-semisolid matter identical to colonic content, indicating complete dehiscence of the anastomosis.
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