Anastomotic Leak Symptoms, Causes, Timing, Diagnosis, Treatment

It is a fatal complication associated with colorectal surgery. As the name indicates that there may be the chances of leak at the site of surgery performed. Anastomosis is a bypass link which is constructed between two organs. And in colorectal surgery, it is between colon and rectum part. It is the most common complication seen in any surgery of GIT. It is considered fatal condition as, if not diagnosed at early stage, then it can lead to contamination of GIT and sepsis can occur and ultimately many organs of GIT will fail to work and ultimately die.

Anastomotic Leak Symptoms

The following symptoms may be seen in patient with anastomotic leak:

• Patient may feel tachycardia i.e. increased heart beat
• Fever and chills can be the visible symptoms
• Major symptom associated is abdominal pain as the leak is effecting the organs nearby and making them nonfunctional.
• Leakage also appears from the outside cut at abdomen applied during surgery.
• Patient feels nausea and sometimes smelly vomiting due to leak.
• As leakage also effects the cardiac activity, so signs of heart attack can also occur like pain in left side of shoulder.
• Blood pressure may also low

Anastomotic Leak Causes

The main cause behind the anastomotic leak is the inappropriate surgery, but some of the assisting causes may be:

• Inadequate blood supply to the site due to tension on the suture line.
• Hygienic condition and sepsis may occur due to inappropriate excretion of fluid in pelvic region.
• The chemotherapy, radiotherapy and steroid therapy taking patient is at higher risk.
• Age is also a factor assisting anastomotic leak.
• Other associated diseases may also be the cause to anastomotic leak
• Coagulation during surgery and shock during the surgical operation.
• Leak can also occur if the bowel is not cleaned well before surgery

Anastomotic Leak Timing

The data about the timing of anastomotic leak is very limited. A research about anastomotic leak is done in an institute and 28 out of 1615 patients show anastomotic leak after surgery. 22 patients out of 28 show leak within 30 days after surgical operation and remaining 6 patients show anastomotic leak after 30 days of time period with average of within 165 days. The patients with late occurrence of anastomotic leak may not managed well with treatment plan after surgery. So it was concluded that management and routine monitoring of patients is required up to 6 months after surgery.

Anastomotic Leak Diagnosis

As diagnosis is the most important part in treating the patients with anastomotic leak. Early diagnosis is required to make the patients safe and decrease the mortality (death) rate. The most common method of diagnosing anastomotic leak is computed tomography scan (CT scan). CT scan is done to the abdominal and rectal part to check the location of leakage. Some of the patients with less leakage or very early stage of leakage will not respond to CT scan and for those patients endoscopy is recommended. Endoscopy show the exact location of leakage.

Anastomotic Leak Treatment

Treatment of Anastomotic Leak include transanal drainage to remove accumulated fluids as well as antibiotic therapy to reduce chances of infection. In some case minor surgical procedure is required to pass catheter for drainage and cessation of leakage.