Anastomotic Leak Flashcards
1
Q
What is AL?
A
leak of luminal contents from a surgical join
2
Q
What are the cx of anastomotic leak?
A
- sepsis > MOD > death
3
Q
What are the general features of patients which prompt you to consider anastamotic leak?
A
- not progressing as expected
- deteriorates after surgery
4
Q
What are the RF of AL?
*think patient and surgical factors
A
Patient factors
- corticosteroids & immunosuppresion
- smoking
- alcohol
- DM
- obesity
Surgical factors
- Emergency surgeries
- Longer intra-operative time
- peritoneal contamination
- oesophageal-gastric or rectal anastomosis
5
Q
When would AL present?
A
- 5-7 days pot-op
6
Q
What are the clinical features of AL?
A
- abdominal pain
- fever
- tachycardic
- peritonism
7
Q
What Ix would you order for AL?
A
- CT scan c contrast CAP - definitive
- urgent routine blood test
- VBG
- G+S
8
Q
How would you Mx AL?
A
Initial
- NBM
- Broad spec abx
- IV fluid
- urine catheter
Definitive
- percutaneous drain
- exploratory laporotomy
9
Q
What is the tx for minor leaks (collection <5cm)?
A
- IV abx
10
Q
What is the tx for large leaks?
A
- percutaneous draining
11
Q
What is the tx if pt is septic and has multiple collections?
A
- exploratory laporotomy
