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Review
. 2021 Oct 1;34(6):400-405.
doi: 10.1055/s-0041-1735271. eCollection 2021 Nov.

Management of Acute Anastomotic Leaks

Traci L Hedrick  1 , William Kane  1
Affiliations
Review

Management of Acute Anastomotic Leaks

Traci L Hedrick et al. Clin Colon Rectal Surg. .

Abstract

Management of the acute anastomotic leak is complex and patient-specific. Clinically stable patients often benefit from a nonoperative approach utilizing antibiotics with or without percutaneous drainage. Clinically unstable patients or nonresponders to conservative management require operative intervention. Surgical management is dictated by the degree of contamination and inflammation but includes drainage with proximal diversion, anastomotic resection with end-stoma creation, or reanastomosis with proximal diversion. Newer therapies, including colorectal stenting, vacuum-assisted rectal drainage, and endoscopic clipping, have also been described.

Keywords: anastomotic leak; colorectal surgery; colostomy; endoscopy; ileostomy.

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Conflict of interest statement

Conflict of Interest None declared.

Figures

Fig. 1
Fig. 1
Gastrograffin enema of a small, contained, anastomotic leak. Arrows demonstrate anastomotic leak with extravasation of contrast posterior to a distal rectal anastomosis.
Fig. 2
Fig. 2
Sagittal CT image of the contained anastomotic leak with 4-cm abscess posterior to the staple line (indicated by arrow). CT, computed tomography.
Fig. 3
Fig. 3
Axial CT image demonstrating complete dehiscence of staple line with surrounding free fluid and extraluminal air consistent with major anastomotic leak. CT, computed tomography.
Fig. 4
Fig. 4
Treatment algorithm for management of acute colorectal anastomotic leaks.
See this image and copyright information in PMC

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