Gonzalez et al evaluated patients with anastomotic leak after gastric bypass for obesity. Early diagnosis and management can be important to prevent complications. A high index of suspicion is often required to make the diagnosis since objective evidence may be limited. The authors are from the University of South Florida, Mayo Clinic, Emory University, and the Cleveland Clinic.


Physical examination in these patients may be limited by the obesity.


Clinical findings of an anastomotic leak may include:

(1) fever

(2) tachycardia

(3) abdominal pain

(4) purulent drainage from a surgical drain


Signs of systemic toxicity with hemodynamic instability:

(1) hypotension

(2) oliguria which may progress to acute renal failure


Classification of onset:

(1) early - within 48 hours of surgery

(2) late - more than 48 hours after surgery


The leakage can be identified:

(1) on an upper GI series

(2) on CT scan

However, 30% of cases will be missed by these methods.


Laparoscopy or celiotomy may be necessary for diagnosis with negative imaging studies if there is a high degree of clinical suspicion.


Nonoperative management can be attempted in the hemodynamically stable patient:

(1) NPO

(2) intravenous broad spectrum antibiotics

(3) maintenance of surgical drains


Indications for surgical management - one or both of the following:

(1) worsening of symptoms on nonoperative management

(2) signs of systemic toxicity with hemodynamic instability


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