Rectal anastomotic leak

Case contributed by Dr Ian Bickle


Rectal malignancy. Worsening symptoms 2 weeks post op.

Patient Data

Age: 70 years
Gender: Male

Pre operative


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


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


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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