Morgenstern et al identified local and systemic risk factors for leakage following a low colonic anastomosis. The authors are from Cedars-Sinai Medical Center in Los Angeles.


Systemic risk factors for a colonic anastomotic leak:

(1) advanced age

(2) obesity

(3) poor nutritional status

(4) chronic corticosteroid therapy

(5) diabetes mellitus

(6) uremia

(7) coagulopathy (bleeding disorder)


Many of these factors are related to poor wound healing.


Local risk factors for a colonic anastomotic leak:

(1) active infection or inflammation at the anastomotic site (abscess, fistula, peritonitis)

(2) gross fecal spillage during the surgical resection

(3) technical difficulties in performing the anastomosis

(4) intramural inflammation or ischemia at the line of resection


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