A negative scan: a scan that cannot say no
Educational use only. Not clinically reviewed68-year-old man for calm course recording, evidence-boundary review, escalation to the operating team, and handoff practice. About 9 simulated minutes.
What you will practise
- Record the operation as the course everything else is read against.
- Record the failure to progress against that course rather than a single reading.
- Recognize that a reported negative scan does not exclude the leak.
- Return the patient to the team that made the anastomosis.
- Record bounded qualified-team surgical intent without selecting anything.
- Review the boundaries and their certainty on both sides.
- Hand off a trajectory rather than a set of numbers.
Review and sources
Not clinically reviewed. No clinician has signed this scenario.
- Erb L, Hyman NH, Osler T. Abnormal vital signs are common after bowel resection and do not predict anastomotic leak. J Am Coll Surg. 2014;218(6):1195-9. 452 consecutive patients undergoing intestinal anastomosis, July 2009 to July 2011; 141 (31.2%) suffered 271 complications including 19 anastomotic leaks; tachycardia and tachypnea were almost routine, occurring in more than half of patients frequently throughout the postoperative period; the positive predictive value of any aberrant vital sign or white blood cell count ranged between 4% and 11%.
- Kornmann VN, van Ramshorst B, Smits AB, Bollen TL, Boerma D. Beware of false-negative CT scan for anastomotic leakage after colonic surgery. Int J Colorectal Dis. 2014;29(4):445-51. 524 patients with a leakage rate of 10.9% (n=57) and mortality after leakage of 21.1% (n=12); CT sensitivity 0.59 (95% CI 0.43-0.73), specificity 0.88 (95% CI 0.75-0.95), positive predictive value 0.82 (95% CI 0.64-0.92), negative predictive value 0.70 (95% CI 0.57-0.81), accuracy 74%; delayed reintervention due to a false-negative CT outcome resulted in death in 62.5% (n=5).
- Marres CCM, van de Ven AWH, Leijssen LGJ, Verbeek PCM, Bemelman WA, Buskens CJ. Colorectal anastomotic leak: delay in reintervention after false-negative computed tomography scan is a reason for concern. Tech Coloproctol. 2017;21(9):709-714. 628 patients reviewed, CT performed in 127, leakage in 49 (7.8%); positive and negative predictive values 78% and 88%, sensitivity 73%, specificity 91%; mortality after a false-negative scan 5/11 (45.5%) against 1/24 (4.2%) (p<0.005), with a significant increase in length of stay.
Open Sim Lab is an educational simulator, not for clinical use. It is not a clinical decision-support tool, not a dosing calculator, and is not validated for any decision affecting a real patient.