Presentation
Sleeve gastrectomy 5 days ago, followed by abdominal pain and fever.
Patient Data
CT study shows:
Postoperative changes related to sleeve gastrectomy
A large collection is seen at the operative bed related to the staple line measures about 10x13x16 cm (about 1000 cc) shows thin marginal enhancement, internal air/fluid level with blurred surrounding fat planes. The mean density of this collection measures 14 HU in the plain study and 27 HU in the post-oral contrast study
Mild pelvic free collection
Mild hepatomegaly and post cholecystectomy surgical clips
The annotated images highlight the mean density of the collection in the plain and post-oral contrast study
Case Discussion
Here is a case of post sleeve gastrectomy leak with abscess formation, one of the early complications of sleeve gastrectomy.
Differential diagnosis of post sleeve gastrectomy collection includes; leak with an abscess and hematoma. The latter presents high density however it may be also infected giving a similar appearance to the abscess.
In this case, despite the absence of gross oral contrast leak, the increasing collection mean density in the post-oral contrast study compared to the plain one suggests underlying staple line leakage with abscess formation.
Assessment of the post-operative leak is one of the indications of oral contrast in the CT abdominal studies.