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Review
. 2021 Nov 23;34(6):406-411.
doi: 10.1055/s-0041-1732322. eCollection 2021 Nov.

Diagnosis and Management of Chronic Anastomotic Leak

Anuradha R Bhama  1 , Justin A Maykel  2
Affiliations
Review

Diagnosis and Management of Chronic Anastomotic Leak

Anuradha R Bhama et al. Clin Colon Rectal Surg. .

Abstract

Chronic anastomotic leaks present a daunting challenge to colorectal surgeons. Unfortunately, anastomotic leaks are common, and a significant number of leaks are diagnosed in a delayed fashion. The clinical presentation of these chronic leaks can be silent or have low grade, indolent symptoms. Operative options can be quite formidable and highly complex. Leaks are typically diagnosed by radiographic and endoscopic imaging during the preoperative assessment prior to defunctioning stoma reversal. The operative strategy depends on the location of the anastomosis and the specific features of the anastomotic dehiscence. Low colorectal anastomosis (i.e. following low anterior resection) may require a transanal approach, transabdominal approach, or a combination of the two. While restoration of bowel continuity is encouraged, it is not infrequent for a permanent ostomy to be required to maximize patient quality of life.

Keywords: anastomotic leak; anastomotic sinus; chronic anastomotic leak; pelvic abscess; reoperative pelvic surgery.

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Conflict of interest statement

Conflict of Interest None declared.

Figures

Fig. 1
Fig. 1
Luminal opening of anastomotic sinus.
Fig. 2
Fig. 2
Purulent drainage from anastomotic sinus.
Fig. 3
Fig. 3
Lower GI study demonstrating chronic anastomotic leak. GI, gastrointestinal.
Fig. 4
Fig. 4
( A ) CT demonstrated a chronic leak. ( B ). MRI demonstrated a chronic leak. CT, computed tomography; MRI, magnetic resonance imaging.
Fig. 5
Fig. 5
Vessel sealing device being used to perform marsupialization of a chronic sinus tract.
See this image and copyright information in PMC

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