Assessment of the clinical usefulness of imaging modalities in identifying postoperative upper gastrointestinal tract leaks requiring reoperation.

Purpose: To assess the usefulness of imaging modalities in the diagnosis and determination of whether postoperative upper gastrointestinal tract leak (UGITL) requires operative intervention.

Methods: : Patients with suspected UGITL who underwent reoperation ≤ 30 days after the primary operation with intraoperative confirmation of leaks were identified. Data of those patients who had undergone computerized tomography (CT) or upper gastrointestinal contrast study (UGIS) before reoperation were reviewed. The usefulness and impact of imaging studies obtained before reoperation were evaluated.

Results: Thirty patients with confirmed UGITL were identified, 24 of whom had undergone imaging studies before reoperation. Fourteen CTs (63.7%) and 4 UGIS (67%) were positive or highly indicative of UGITL. The interval between the primary operation and the reoperation and the morbidity rates after the reoperation were similar between patients with and those without imaging studies before the reoperation (5.6 ± 4.8 vs. 6.8 ± 4.2 d, P=0.55; 91.6% vs. 100%, P=0.29, respectively). False-negative imaging results caused postponement of reoperation by ≥ 24 hours in 4 patients whose outcome was similar to those with true-positive results.

Conclusions: CTs and UGIS are supportive tools when deciding whether to reoperate for postoperative UGITL. However, a negative imaging study for UGITL does not exclude it definitively, and therefore should not replace clinical evaluations.