Anastomotic leak — POD5 anterior resection, spiking fever

Setting

You are the colorectal registrar at a tertiary hospital with 24-hour CT and interventional radiology, and a fixed emergency theatre. It is 20:00 on a Friday.

Patient

Mr O, a 64-year-old man, is post-op day 5 after a laparoscopic low anterior resection for a mid-rectal cancer 8 cm from the anal verge with a stapled colorectal anastomosis, no protective loop ileostomy. He was mobilising and eating yesterday. Today he has a temperature of 38.7, HR 118, BP 108/70, mild diffuse abdominal tenderness, CRP 245 (previously 180 on POD3), and cloudy drain effluent.

Reference stack

Bailey & Love 28e Ch 74 · Sabiston 21e Ch 52 · Dutch anastomotic leak severity score · IDEAS 2016 · ISREC anastomotic leak classification