resection could present with similar symptoms in the setting of postoperative visceral injury and/or anastomotic leaks. In this scenario, particular emphasis is often placed on ascertaining the integrity of an anastomosis, most often using CT with positive oral and IV contrast and/or fluoroscopic studies. Radiography Abdomen There are no recent studies evaluating the use of radiographs in the setting of nonlocalized abdominal pain and fever in the postoperative patient, and its role is limited in the detection of abscesses. Although it has been shown to have high sensitivity (90%) for detecting intra-abdominal foreign bodies and moderate sensitivity for detecting bowel obstruction (49%), it has low sensitivity for sources of abdominal pain and fever or abscess, which limits its role in this setting [15]. If there is concern for retained surgical instrument or sponge, a radiograph may be useful in this population because of the classic appearance of surgical sponge markers on radiographs. Fluoroscopy Although limited in the detection of abscesses, fluoroscopic examinations are useful in the evaluation of some intestinal postoperative leaks, particularly when there are equivocal findings on CT [47]. Fluoroscopic examinations can be augmented or complemented by the use of CT with positive oral contrast in the evaluation of a potential leak, as discussed below. CT has the added advantage of allowing for abscess drainage should nonoperative or endoscopic management be pursued in the setting of postoperative leaks. Fluoroscopy Contrast Enema In the setting of recent colorectal anastomoses, one study demonstrated that water-soluble enemas may have better sensitivity for detecting distal anastomotic leaks than CT, but neither was sensitive for a leak if the patient had a proximal colonic anastomosis [47]. Fluoroscopy Upper GI with SBFT The sensitivity of upper GI contrast examinations for detecting leaks after bariatric surgery varies among reports between 22% to 79% [48-51].
Acute Nonlocalized Abdominal Pain. resection could present with similar symptoms in the setting of postoperative visceral injury and/or anastomotic leaks. In this scenario, particular emphasis is often placed on ascertaining the integrity of an anastomosis, most often using CT with positive oral and IV contrast and/or fluoroscopic studies. Radiography Abdomen There are no recent studies evaluating the use of radiographs in the setting of nonlocalized abdominal pain and fever in the postoperative patient, and its role is limited in the detection of abscesses. Although it has been shown to have high sensitivity (90%) for detecting intra-abdominal foreign bodies and moderate sensitivity for detecting bowel obstruction (49%), it has low sensitivity for sources of abdominal pain and fever or abscess, which limits its role in this setting [15]. If there is concern for retained surgical instrument or sponge, a radiograph may be useful in this population because of the classic appearance of surgical sponge markers on radiographs. Fluoroscopy Although limited in the detection of abscesses, fluoroscopic examinations are useful in the evaluation of some intestinal postoperative leaks, particularly when there are equivocal findings on CT [47]. Fluoroscopic examinations can be augmented or complemented by the use of CT with positive oral contrast in the evaluation of a potential leak, as discussed below. CT has the added advantage of allowing for abscess drainage should nonoperative or endoscopic management be pursued in the setting of postoperative leaks. Fluoroscopy Contrast Enema In the setting of recent colorectal anastomoses, one study demonstrated that water-soluble enemas may have better sensitivity for detecting distal anastomotic leaks than CT, but neither was sensitive for a leak if the patient had a proximal colonic anastomosis [47]. Fluoroscopy Upper GI with SBFT The sensitivity of upper GI contrast examinations for detecting leaks after bariatric surgery varies among reports between 22% to 79% [48-51].