Common complication of GI surgery, following resection and primary anastamosis. Diagnosis, differentials, treatment. Slides compiled as part of medical school studies. Sources for all imagery and sources listed in references section where possible. I do not claim ownership of any images or graphics. Slides for educational purposes only, and should not replace clinical judgement. No monetary gain was made for this work.

1. Case 42
You are called to a patient who has been hospitalised for
sigmoid colon cancer. He is on the 5th postoperative day.
He passed stool 2 days ago. A drain was removed today.
This evening he is complaining of severe weakness, chills
and abdominal pain.
On physical examination the abdomen is distended, the
wound is sutured and healing, and you notice peritoneal
signs with no peristalsis.

2. Differential Dx.
 Postoperative ileus – too long, passed stool two
days ago
 Obstruction – weakness/chills, unlikely after initial
bowel movements
 Ogilvie – no age given, surgery likely cause

3. Anastomotic leak
 Pt. Shows symptoms of acute
abdomen, suggestive of infection
 Primary anastomosis after colorectal
resection
 Leakage of large bowel contents →
peritonitis, extremely high risk of
sepsis

4. Primary colorectal
anastomosis

5. Treatment
 Immediate surgery
 Antibiotics against G- rods/anaerobes,
e.g. ciproflaxacin-metronidazole
 Treat sepsis if required:
 Supplemental O2
 Aggressive broad spec. antibiotics
 IV fluid bolus, repeated as necessary to maintain
systemic pressure and avoid septic shock

6. Hartmann’s
Procedure