Drain fluid iodine as a biomarker of anastomotic leak after low anterior resection in patients undergoing Gastrografin rectal tube flushes and omission of a diverting ileostomy: The GUSH study

Figures

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  FIGURE 1. Imaging on day of anastomotic leak.

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  FIGURE 2. Time course of drain fluid iodine in patients experiencing anastomotic leak (AL) as measured by dual‐energy CT (DECT) (D1 etc., day 1 etc.). Arrows indicate the day of clinical diagnosis of AL; the dotted line represents the derived cutoff of the highest mean plus three standard deviations in the non‐AL group. The cutoff was 0.240 mg/mL in non‐AL drain fluid, seen as highest on D1. There was insufficient drain fluid collected for analysis for GUSH_65 on day 5, which was the day of AL.

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  FIGURE 3. Time course of drain fluid iodine in patients experiencing anastomotic leak (AL) as measured by inductively coupled plasma mass spectroscopy (ICPMS) (D1 etc., day 1 etc.). Arrows indicate the day of clinical diagnosis of AL; the dotted line represents the cutoff derived from the highest mean at any day plus three standard deviations in the non‐AL group (cutoff, background, was 130 μmol/L, D1_am).

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  FIGURE 4. Drain fluid iodine on the day of anastomotic leak (AL) versus day 3 of non‐AL (dual‐energy computed tomography, DECT) and day 3 (−12 h). DoL, day of anastomotic leak; DoL (−12 h), 12 h before diagnosed day of leak. The dotted line marks the cutoff (background mean of the non‐AL group plus three standard deviations).

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  FIGURE 5. Drain fluid iodine on day of anastomotic leak (AL) versus day 3 of non‐AL (induction coupled mass spectroscopy, ICPMS). DoL, day of anastomotic leak. The dotted line marks the cutoff (background mean of the non‐AL group plus three standard deviations).

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  FIGURE 6. Iodine measured in the nonanastomotic leak (non‐AL) group by dual‐energy computed tomography (DECT) and inductively coupled plasma mass spectroscopy (ICPMS). (A) DECT‐measured iodine levels in the non‐AL group. (B) ICPMS measured iodine in the non‐AL group. D1, postoperative day 1. The dotted line marks the cutoff (background mean of the non‐AL group plus three standard deviations).