Figure 8.

New gas collection following diverticulectomy and fundoplication for epiphrenic diverticulum. (a, b) Pre-operative frontal chest radiograph and chest CT show large narrow necked diverticulum (arrows). (c) Post-operative chest radiograph shows large air-filled collection which does not decompress following NG tube placement raising concern for leak. (d) The collection communicates with the oesophagus filling with oral contrast (arrow). (e, f) Sagittal and coronal chest CT images reveal air-filled structure to be supradiaphragmatic, with mucosal folds. Findings are consistent with herniation and incarceration of the gastric fundus above the wrap mimicking a leak. This was confirmed on endoscopy. Teaching point: peri-anastomotic collections which fill with oral contrast may sometimes represent a herniating viscus rather than a true leak; hence, knowledge of post operative anatomy is key. Percutaneous drainage of perianastomotic collections should not be recommended unless these are accurately characterized as true leaks and a herniating viscous is excluded.