{"title":"Considerations in case of suspected anastomotic leakage in the lower GI tract","authors":"","doi":"10.1016/j.bpg.2024.101925","DOIUrl":null,"url":null,"abstract":"<div><p>Colorectal anastomotic leakage (CAL) remains a feared complication after colorectal surgery and requires prompt detection and proper treatment. With the upswing of fast-track recovery programs in recent years this challenge has increased, as clinical features may only arise after discharge. Therefore, identification of the best diagnostic tools is of utmost importance, also since early treatment is associated with high success rates. Diagnostic tools range from general screening tools to invasive procedures to assess the severity of the leak. Laboratory tests, in particular the inflammation biomarkers C-reactive protein and procalcitonin, have a significant role in the detection of CAL after colorectal surgery. As these biomarkers are unspecific for CAL, additional imaging should be performed when blood levels are elevated. The golden standard for the detection of AL after colonic resections is a computed tomography (CT-scan). If tolerated, a contrast medium should be administered rectally to enhance diagnostic accuracy. When suspicion of CAL remains high despite negative previous tests, further endoscopy examination should be conducted. However, endoscopic examinations become more suitable for the early diagnostic work-up after rectal resections. This review aims to provide an overview of current diagnostics for the screening and assessment of the severity of CAL after colorectal surgery.</p></div>","PeriodicalId":56031,"journal":{"name":"Best Practice & Research Clinical Gastroenterology","volume":null,"pages":null},"PeriodicalIF":3.2000,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1521691824000507/pdfft?md5=234a8c41dad1c66d99915a982008c9f2&pid=1-s2.0-S1521691824000507-main.pdf","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Best Practice & Research Clinical Gastroenterology","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1521691824000507","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"GASTROENTEROLOGY & HEPATOLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Colorectal anastomotic leakage (CAL) remains a feared complication after colorectal surgery and requires prompt detection and proper treatment. With the upswing of fast-track recovery programs in recent years this challenge has increased, as clinical features may only arise after discharge. Therefore, identification of the best diagnostic tools is of utmost importance, also since early treatment is associated with high success rates. Diagnostic tools range from general screening tools to invasive procedures to assess the severity of the leak. Laboratory tests, in particular the inflammation biomarkers C-reactive protein and procalcitonin, have a significant role in the detection of CAL after colorectal surgery. As these biomarkers are unspecific for CAL, additional imaging should be performed when blood levels are elevated. The golden standard for the detection of AL after colonic resections is a computed tomography (CT-scan). If tolerated, a contrast medium should be administered rectally to enhance diagnostic accuracy. When suspicion of CAL remains high despite negative previous tests, further endoscopy examination should be conducted. However, endoscopic examinations become more suitable for the early diagnostic work-up after rectal resections. This review aims to provide an overview of current diagnostics for the screening and assessment of the severity of CAL after colorectal surgery.
结肠直肠吻合口漏(CAL)仍然是结肠直肠手术后令人恐惧的并发症,需要及时发现并进行适当治疗。近年来,随着快速康复计划的兴起,这一挑战也越来越大,因为临床特征可能在出院后才出现。因此,确定最佳诊断工具至关重要,因为早期治疗的成功率很高。诊断工具包括从一般筛查工具到用于评估泄漏严重程度的侵入性程序。实验室检测,尤其是炎症生物标志物 C 反应蛋白和降钙素原,在结肠直肠手术后的 CAL 检测中发挥着重要作用。由于这些生物标志物对 CAL 并不具有特异性,因此当血液水平升高时应进行额外的影像学检查。结肠切除术后检测 AL 的黄金标准是计算机断层扫描(CT 扫描)。如果可以耐受,应直肠注射造影剂以提高诊断的准确性。如果之前的检查结果为阴性,但对 CAL 的怀疑仍然很高,则应进一步进行内窥镜检查。然而,内窥镜检查更适合直肠切除术后的早期诊断工作。本综述旨在概述目前用于筛查和评估结肠直肠手术后 CAL 严重程度的诊断方法。
期刊介绍:
Each topic-based issue of Best Practice & Research Clinical Gastroenterology will provide a comprehensive review of current clinical practice and thinking within the specialty of gastroenterology.