Complications: Early Anastomotic Complications—Leak, Abscess, and Bleeding

Colorectal surgery has experienced significant improvements in surgical techniques, minimally invasive approaches, antibiotic prophylaxis, and perioperative care. In spite of these advancements, anastomotic complications continue to occur and often contribute substantially to postoperative morbidity and mortality. Surgeons must be prepared to identify anastomotic complications early in order to manage them thoughtfully. Infectious complications related to an anastomotic leak may lead to local or generalized peritonitis. Management options range from observation and antibiotic treatment, to image guided drainage and reoperation, based on the location of the leak and the patient’s clinical condition. Hemorrhage from the anastomosis will often resolve without intervention, but in situations where there is a major bleed, management strategies should follow the same principles as any other patient presenting with a lower gastrointestinal bleed.