Total colonic anastomosis breakdown

Case contributed by Dr Ian Bickle

Presentation

Abdominal pain and fever one week following discharge after a right hemicolectomy for splenic flexure tumour.

Patient Data

Age: 69
Gender: Female

Right hemicolectomy.

Large gas-air filled collection extending from the site of the presumed anastomosis ( hepatic flexure ) down into the RIF - bulk dimensions 9 x 7cm.This is contiguous with a site of the anastomosis.

Additional 6.8cm 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 into a large collection of gas-semi-solid matter identical to colonic content, indicating a complete dehiscence of the anastomosis.

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Case information

rID: 46771
Case created: 16th Jul 2016
Last edited: 25th Jul 2016
Inclusion in quiz mode: Included

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