Concerns:
(1) leaking of the anastomosis with peritonitis
(2) adhesions with obstruction
(3) Clostridium difficile disease secondary to antibiotic therapy
(4) surgical site infection
An anastomotic leak may present up to 7 weeks after surgery. A leak may develop later at the operative site if the area was irradiated or if there is ischemia.
Timing of an anastomotic leak:
(1) soon after surgery if the anastomosis is defective or the bowel wall friable
(2) 7 to 10 days after the surgery (causes may include clipping an artery supplying the site)
(3) late (30 to 45 days after)
The patient should be instructed to call the surgeon or to come in for an evaluation if s/he develops:
(1) fever
(2) abdominal pain
(3) change in bowel habits (diarrhea or failure to pass stool)
(4) blood in the stool
(5) drainage or inflammation at an incision (surgical site)
Many cases of anastomotic leak occur after the patient has been discharged. Any delay in seeking help can significantly increase morbidity and mortality. Therefore the patient should avoid travel to a remote location for several weeks after the surgery.
