Anastomotic leak status post partial esophagectomy and gastric
Helical CT of the chest (Figure 1) with 3-dimensional (3D)
reconstructions (Figures 2 and 3) was performed with only oral
contrast. The CT also depicts the anastomotic leak. A dense
collection of contrast was present to the left of the gastric
pull-up and anterior to the spine, extending from the thoracic
inlet to the level of the left atrium, because of a leak at the
Traditionally, cine-esophagrams have been used to evaluate
postoperative anatomy and complications following esophagectomy and
gastric pull-up. The development of multidetector computed
tomography (MDCT) and 3D software now allows new methods for
visualization and evaluation of this complex postoperative anatomy.
Cine-esophagram is widely used in the analysis of esophagectomy
patients to evaluate for postoperative complications, such as
leaking from the anastomotic site. CT has also been used to look
for subtle leaks or postoperative complications because of better
With the advent of 3D imaging, this complex postoperative
anatomy becomes even clearer. Reconstructions can be performed in
any plane. Our surgeons have found this more useful and helpful for
planning repeat surgeries, as images can be reproduced in a
familiar format. Three-dimensional imaging can manipulate the data
set to resolve issues that are confusing in the axial plane alone,
such as determining the site of the leak or the extent of fluid
collection. As demonstrated in this case, the site of leak, the
pooling of contrast, and their relationship to the gastric pull-up
are easier to visualize on the coronal and sagital reconstructed
images than on the axial plane alone.
Three-dimensional CT can provide additional information and can
be a problem-solving tool in complicated postesophagectomy
patients. Reconstructed images often make it easier for the
referring surgeon to visualize the anatomy and pathology in order
to plan necessary therapy.
- Heiken JP, Balfe DM, Roper CL. CT evaluation after
esophagogastrectomy. AJR Am J Roentgenol.1984;143:555-560.
- Gimenez A, Franquet T, Erasmus JJ, et al. Thoracic
complications of esophageal disorders.