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Treatment of Anastomotic Leakage Following Low Anterior Colon Resection
William J. Mileski, MD;
Raymond J. Joehl, MD;
Robert V. Rege, MD;
David L. Nahrwold, MD
Arch Surg. 1988;123(8):968-971.
Abstract
• Four hundred five consecutive cases of low anterior colon resection were studied to determine the best treatment of anastomotic leak. The triad of fever, leukocytosis, and pelvic pain was present in 15 of the 16 cases with leaks. Four (25%) of the 16 patients died. Eleven were managed by proximal decompression and drainage; four died (36%). Three patients underwent takedown of the anastomosis, end colostomy, and distal closure or exteriorization; none died. Neither of the two patients who had drainage alone died. Anastomotic leakage accounted for two thirds of the deaths in this series. Recognition of the clinical triad of fever, leukocytosis, and pelvic pain could lead to earlier diagnosis and improved outcome. Our data suggest that a procedure that includes takedown of the anastomosis, end colostomy, and closure of the rectum is the most efficacious treatment of anastomotic leakage after low anterior colon resection.
(Arch Surg 1988;123:968-971)
Author Affiliations
From the Department of Surgery, Northwestern University Medical School, and the Surgical Service, Veterans Administration Lakeside Medical Center, Chicago.
Footnotes
Accepted for publication Jan 5, 1988.
Read before the 95th Annual Meeting of the Western Surgical Association, Dallas, Nov 18, 1987.
Reprint requests to Department of Surgery, Northwestern University Medical School, 250 E Superior St, Suite 201, Chicago, IL 60611 (Dr Nahrwold).
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