After a bowel anastomosis, a leak rarely begins with peritonitis. The earliest signs are usually non-specific: an unexplained heart rate above 100, new atrial fibrillation, a rising respiratory rate, confusion in an older patient, or a patient who was improving and now is not. A C-reactive protein that keeps rising on day 3 to 5 instead of falling adds weight. Attributing these to chest infection or pain delays the diagnosis that decides survival.
- Treat persistent unexplained tachycardia after an anastomosis as a leak until proven otherwise.
- Check C-reactive protein on day 3–5; a rising rather than falling trend warrants imaging.
- Obtain CT with contrast early rather than waiting for peritonism to develop.
- Do not accept new atrial fibrillation or confusion after bowel surgery without looking for sepsis.
Why it matters
Leak mortality is driven by delay, and the early signs are easy to attribute to something else.
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