Anastomotic leak

Death and surgical complications seem relatively unambiguous outcomes. However, some indicators of morbidity, such as wound infection, anastomotic leak and postpartum haemorrhage are difficult to define with precision (Lilford etal, 2004). Even death can pose difficulties of classification, in the sense that a death in hospital can simply mean the arrival of a terminally ill person who died shortly after admission. A death in those circumstances says nothing at all about the quality or safety of care in that hospital. 

Urschel JD (1995) Esophagogastrostomy anastomotic leaks complicating esophagectomy a review. Am J Surg... 

Fig. 2.12. Post-anastomotic narrowing of the esophagus. Routine post-operative swallow with non-ionic isotonic contrast medium shows esophageal narrowing at the primary anastomosis without evidence of hold up. No leak was demonstrated. Tracheomalacia is evident. Contrast medium in the airway is the result of an episode of aspiration (arrow)...

Bile leaks are usually early complications they may originate from the anastomotic site, the cystic duct stump, the cut surface of the liver or they may be related to the T-tube (Fig. 4.2.24). 

MRCP is helpful in the detection of biliary strictures, bile leaks, and biloma formation. Thick-slab MRCP images are particularly useful in the presence of biliary dilatation (Fig. 4.2.25). However, proximal biliary dilatation may be absent in the transplanted patient with stenosis at the anastomotic site (Laghi et al. 1999 Pandharipande et al. 2001). Careful analysis of thin-slice MR images can help to identify the stricture and/or leak (Fig. 4.2.26). False MR positive and negative results may occur in the presence of surgical clips due to susceptibility artifact obscuring the biliary ducts. 

Airway dehiscence can be suspected when a pneumothorax with a persistent air leak occurs some days after the operation or anastomotic wound healing problems are detected via bronchoscopy. 

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