What Is an Anastomotic Leak?

Medically Reviewed by Poonam Sachdev on August 24, 2022
Written by Julian Selemin
4 min read

Anastomotic leaks refer to a post-surgery complication that arises from procedures such as bowel resection and gastric bypass. While they can be fixed, they’re an important factor to keep in mind when procedures that involve anastomosis are on the table. That way, early detection can lead to an easier fixing procedure. 

Here’s what you need to know.

An anastomotic leak is one of the possible complications that may arise after the surgical connection of intestinal channels. Specifically, it refers to the leaking of the contents of your gut when the two ends of the channel aren’t sealed correctly. When this happens, the contents of your gastrointestinal tract leak out.

While it may not seem obvious, the leaking of gastrointestinal contents can be very harmful to your body. Your gut contains bacteria that help digest food and are a key part of your body — however, the rest of your abdominal cavity doesn’t have such flora. Therefore, when the contents of your intestine leak out, they can cause serious infections.

Anastomotic leaks are tied to anastomosis, which is the procedure that connects two ends of a channel together by sealing them. The most common type of operation that involves anastomosis is bowel resection — a surgery that removes part of or the entirety of your colon. However, there are other procedures that also involve anastomosis, like a gastric bypass.

While anastomotic leaks are not the most common of the possible anastomosis complications, they occur after about 1 out of 20 surgeries. This might seem like a high risk for some people, but it’s crucial to remember that, if caught early, anastomotic leaks can be easily fixed by a team of experts.

After a surgery that involved anastomosis, your doctor will probably ask you to keep an eye out for symptoms that may develop during the following days. These are usually indicators that the connection failed, inducing an anastomotic leak. Here are some of the common signs:

  • Fever
  • Stomach or abdominal pain
  • Nausea
  • Vomiting
  • Low blood pressure
  • Increased heart rate

Naturally, it’s also a good idea to perform frequent visual inspections of the surgical wound during the first few days after the procedure. Sometimes, an anastomotic leak will cause drainage from the wound, which warrants a visit to the doctor. Also, anastomotic leaks can manifest through reduced urine output or pain in your left shoulder.

There are several stages involved in treating an anastomotic leak, but how many of them you’ll need to go through will mostly depend on the severity of your case. If the leak is caught early, it’s possible that you may only need to take some antibiotics for a set amount of time until the infection recedes. 

However, if the infection has already been growing for a while, your doctor may need to perform a drainage. This consists of inserting a hollow needle through your skin to siphon out contaminated fluid caused by the infection. That helps reduce swelling from a possible inflammation. 

Depending on where the leak is, you may also need to avoid eating and drinking until the condition is treated. In that case, you may need to remain at the hospital, where your team of doctors will administer intravenous fluids.

In the most severe cases, doctors may need to perform surgery. While this doesn’t necessarily involve another anastomosis, it may involve a laparoscopy — an examination of the abdomen through a small camera. Then, the surgeon may try to drain the infection through a tiny incision and wash the zone with an antiseptic.

Lastly, if no other option is possible, a team of surgeons will need to reopen the body cavity to access the infected area. They may choose to perform a reinforcement of the anastomosis or simply bypass that section temporarily through an ostomy — a new opening that bypasses a certain region of your intestinal tract.

There are many factors that contribute to a possible anastomotic leak. Unfortunately, many are related to uncontrollable variables. Mainly, anastomotic leaks relate to the health status of each person and the difficulty of both the surgery itself and the post-procedure process. 

There are some factors that can increase the risk of anastomotic leaks. Your doctor will let you know if any of these are present in you — however, it’s always a good idea to know beforehand if you’re at risk. Some of the risk factors for anastomotic leaks include:

Furthermore, the duration of the procedure can also influence the risk for anastomotic leaks — longer surgeries are linked to higher probabilities of leakage. Also, males are at a higher risk of anastomotic leaks due to anatomical reasons.

Unfortunately, there aren’t many ways to prevent an anastomotic leak besides closely following your doctor’s advice regarding post-procedure precautions. A doctor will screen you before the surgery to diagnose possible risk factors and possibly prevent anastomotic leaks. Here are some of the tests you may be subjected to during or after the surgery:

  • Air testing — by filling your body cavity with a saline solution, surgeons can detect possible leaks by observing whether or not bubbles appear.
  • Fluid test — by introducing liquid through your intestinal channel, doctors can check if the ends are connected properly. 
  • Contrast test — sometimes, surgeons will ask for a CT scan, which lets them see if a contrast dye leaks out of your intestine.

As you can see, these tests involve a team of doctors and are usually done while you’re staying at the hospital. To prevent anastomotic leaks at home after the surgery, make sure to closely adhere to the post-procedure indications and regularly check for the common symptoms it causes. If you have any doubts, make sure to check with your doctor for further advice on how this condition can be prevented.