Anastomotic Leak

Question 1

Definition anastomotic leak

Answer 1

Leak of luminal contents from a surgical join

They are the most important complication to recognise following GI surgery

Question 2

Risk factors

Answer 2

Medication like corticosteroids and immunosuppressant

Smoking or alcohol excess

DM

Obesity or malnutrition

Emergency surgery

Longer intra-op time

Peritoneal contamination (from pus, faeces, GI contents)

Oesophageal-gastric

Question 3

Clinical features

Answer 3

Abdominal pain and fever

5-7 days post-OP usually.

Pyrexial, tachycardic +/- features of peritonism.

Check for faeculent/purulent material or bile in any drains.

Question 4

Investigations

Answer 4

CT abdo pelvis with IV contrast is the definitive investigation

Early resus and senior input

Urgent blood tests with FBC, CRP, U&Es, LFTs and clotting screen

VBG to assess degree of tissue perfusion

Repeat G&S

Question 5

Initial management

Answer 5

NBM + start broad spectrum abx cover per local guidelines.

Start IV fluids and insert a urinary cath to monitor fluid balance

Question 6

Definitive management for minor leaks

Answer 6

May be managed conservatively

Collections of <5cm will usually settle with IV abx

Question 7

Definitive management for major leaks

Answer 7

Drained percutaneously if possible.

Question 8

Management if the patient is septic or has multiple collections?

Answer 8

Exploratory laparotomy with large drain insertion