After bowel anastomosis, a leak rarely announces itself with peritonitis on the first day. The early signs are quieter: a rising heart rate, new atrial fibrillation, a low-grade fever, a patient who is not progressing as expected, prolonged ileus, or new confusion in an older person.
A persistent unexplained tachycardia above about 100 beats per minute after colorectal surgery deserves examination, blood tests including CRP, and a low threshold for contrast CT. A normal abdomen on examination does not exclude a leak in the early days, particularly in older patients or those on steroids.
- Treat persistent unexplained tachycardia after an anastomosis as a possible leak until shown otherwise.
- Look for new atrial fibrillation, failure to progress, prolonged ileus and confusion as early signs.
- Check CRP and arrange a contrast CT early when the trajectory is wrong.
- Do not let a soft abdomen reassure you in older patients or those on steroids.
Why it matters
Each day of delay in recognising a leak adds to mortality, and the early signs are easy to attribute to something else.
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