Vascular Risk Factors in Left Colon Anastomosis Leakage: A Computed Tomography Guided Study

摘要: 25 cases of left colon anastomosis, complicated by an early post-operative leakage, have been studied Computed Tomography (CT): in 20 them arterial vascular insufficiency was observed, and considered a pathogenetic factor this pitfall. Introduction Many risk factors order to explain leakage colo-colic or high colo-rectal : ischemia the segments anastomosed, their inadequate mobilization, patient’s poor conditions (1-7). On other hand, utility CT diagnosis peritonitis is well known ( 8-10). We useful tool also demonstrating post-surgical conditions, particularly concerning supply colon, directly correlated anastomotic leakage: has aim present study. Methods examined anastomosis 17 colo-sigmoid 8 colo-rectal) observed years 2010-2012 ; 22 these patients were referred us from centres. performed all within 4th day, with multislice technique intravenous contrast enhancement. The diffuse localized abscess possible cases. Vascular lesions, colonic relevant following morpho-radiological signs indicative 1)Arterial hypovascularization, demonstrated attenuated network mesentery; 2)Poor enhancement walls anastomosed segments; 3)Their oedema thickening, absence normal hyper-enhancement mucosa (Illustration 1); 4)Dilatation one both segments. Results All above mentioned found associated 16 severe peritonitis, treated promptly re-laparotomy. A less evident hypoperfusion, only afferent loop 4 pelvic abscess, successfully percutaneous drainage. Discussion Ischemia important anastomotc leakage. It can be proved two fundamental signs: 1)Absence clear mesentery 2,3,4); 2)Contrast hypo-enhancement walls, unclear visualization corresponding mucosa. Oedema easily ascribed ischemic damage micro-circulatory apparatus, while dilatation consequence subsequent autonomous nervous system paralysis, resulting condition muscle atony. same inflammatory venous congestion oedema, lymph nodes enlargement, often small bowels mesentery. demonstrate mesenteric thrombosis, complication infrequent today, because largely diffused anti-thrombotic prophylaxis. Conclusion(s) Surgeons must interested know causes operat ive pi t fal ls, especial ly i f related anatomo-surgical factors; case dehiscence insufficiency, which (11-13). Webmedcentral > Original Articles Page 2 14 WMC003346 Downloaded http://www.webmedcentral.com on 13-Jun-2012, 09:00:01 PM frank followed obliging prompt re-laparotomy complete take-down anastomosed. An adequate study anatomy obtained pre-operatively CT, permits detect anatomical variations pre-existing pathological supply, subsequently choose operative planning (14,15). intra-operative recognition follow,in perform radical lymphadenectomy, contemporarly assure intestinal segments, before anastomosis. Reference(s) 1. Makela J.T., Kiviniemi H., Laitinen S. Risk factorsfor leakge after left-sided colorectal resection rectal anastomoses. Dis.Colon Rectum2003; 46:653-660. 2. Kingham T.P., Pachter H.L. Colonic leak factors, treatment. J.Am.Coll.Surg. 2009; 208:269-278. 3. Buchs N.C., Gervaz P., Secic M. etal . Incidence,consequence, for surgery: prospective monocentric Int.J.Colorectal Dis. 2008;23:265-270. 4. Lyall A., McAdam T.K., Towned J. et al. Factors affecting complications anterior cancer. Colorectal 2007;9:801-807. 5. Biondo S., Pares D., Kreisler E. Anastomotic primary sided emergencies. Rectum 2005;48: 272-2806 6. Dworkin M.J., Allen-Mersh T.G. Effect artery l igation blood flow marginal-dependent sigmoid colon. 1996; 183:357-360. 7. Chambers W.M., Mortensen N.J. Postoperative formation surgery. Best Pract.Res.Clin.Gastroenterol. 2004;18:865-880. 8. Hoeffel C., Marcus Arrive L. imaging [in French]. Radiologie 2009;90:954-968. 9. Zissin R., Gayer G. anatomic pathologic findings at resection. Semin.Ultrasound MRI 2004; 25:222-238. 10. Manenti Manco G., Vezzelli E., Donatiello Leakage anastomosis:Computed diagnosis. WebmedCentral SURGERY 2012; 3(4):WMC 003264. 11. Allison A.S., Bloom L., FauxW. angiographic arteries collaterals Ann.Surg. 200;251:1092-1097. 12. inferior ligation marginal arterydependent 1996;183:357-360. 13. Meyers M.A. Griffith’s point: critical splenic flexure. Significance AJR Am.J.Roentgenol. 1976;126:77-94. 14. Tomographic interpretation cancer: let there more exhaustive. RADIOLOGY 2012;3(3):WMC 003181. 15. A. hemicolectomy: technical reflections towards standard enlarged procedures. SURGICAL TECHNIQUE 2011; 2(10):WMC 002375. 3