Anastomosis
Formal Definition
A surgically created connection between two hollow structures (bowel, vessels, or ducts) to restore continuity after resection; can be performed hand-sewn or with a stapling device; types include end-to-end, end-to-side, and side-to-side; the integrity of an anastomosis is critical — leakage is a serious, potentially fatal complication.
How It's Used on the Ward
"The anastomosis" or "anastomotic leak" — the surgical join between bowel segments, vessel segments, or ducts; when it fails, it leaks.
Example
""Post-op day 4 after low anterior resection: patient febrile, tachycardic, worsening abdominal pain. CT pelvis shows pelvic fluid collection adjacent to the colorectal anastomosis — anastomotic leak confirmed. Returning to OR for washout and diverting ileostomy.""
Clinical Context
Anastomotic leak (AL): occurs in 3-20% of colorectal anastomoses depending on location and patient risk factors. Low rectal anastomoses have the highest leak rate. Risk factors: malnutrition, obesity, steroids, neoadjuvant radiation, emergency surgery, poor blood supply. Signs: fever, tachycardia, increased abdominal pain/distension, ileus, feculent wound drainage. Diagnosis: CT with rectal contrast or water-soluble contrast enema. Management: percutaneous drainage if contained, OR if peritonitis or uncontrolled leak. Diverting stoma (ileostomy or colostomy) may be created prophylactically for high-risk anastomoses.
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