Colonic/colorectal anastomotic leakage is a serious potential complication of any colorectal anastomosis. It is associated with high morbidity and mortality, the latter being as high as 50% of the symptomatic cases ¹. Leaks occur in 2% to 51% of colorectal surgeries.

Symptoms usually manifest in the first two postoperative weeks, with most of the cases between days 5 and 7. They consist of fever, intense abdominal pain, tachycardia, guarding and rebound tenderness. Often leaks are completely asymptomatic (occult leaks) ¹.

Multidetector CT is currently the method of choice in diagnosing this condition. Diagnostic certainty is increased when extravasation of luminal contrast material, air, and possible stool is seen outside of the bowel. This appearance can mimic the rectum ("double rectum" sign).

Radiologic findings don't always represent the severity of the leakage, and the management is mostly based on the clinical status¹.