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
