Rectal anastomotic leak

Case contributed by Dr Ian Bickle

Presentation

Rectal malignancy. Worsening symptoms 2 weeks post op.

Patient Data

Age: 70 years
Gender: Male

Pre operative

ct

A barely discernable well defined lesion in the anterior wall of the upper rectum (endoscopically identified prior to CT).

No lymphadenopathy.

Simple hepatic and renal cysts. Prostatomegaly.

Nuclear medicine

A well defined intensely FDG-18 avid mural lesion in the anterior upper rectum.

No local invasion, No metastases.

3 days post op

ct

Pelvic drain.

The ring of rectal anastomotic sutures are intact. Right iliac fossa colostomy.

Small presacral fluid collection. No perirectal gas.

Simple hepatic and renal cysts.  Prostatomegaly.

2 weeks post op

ct

The ring of rectal anastomosis sutures has broken down at 9-10 o'clock with a 3 mm gas-fluid track extending from this site to a presacral gas-fluid collection.

Right iliac fossa colostomy.

Simple hepatic and renal cysts. Prostatomegaly.

Case Discussion

This case with interval imaging clearly demonstrates the breakdown on the rectal anastomosis and a resultant anastomotic leak.

In this case, the exact site of the breakdown can be seen, with a track extending into the gas-fluid collection in the presacral space.

CT is commonly performed in patients with a fever following colonic surgery to assess for post operative collections or leaks.

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