Cohort Definition Name: Anastomotic leak or dehiscence
Contributor name: Andreas Weinberger Rosen
Contributor OrcId: 0000-0001-9990-8155
Logic Description: First event of anastomotic leak or dehiscence of large or small intestine
Recommended study application: exposure, outcome, indication. Created intended to be used after surgery for colorectal surgery.
Assertion statement: This cohort definition was executed on at least one real person-level observational health data source and resulted in a cohort with at least 1 person.
Submitted cohort definition:
Anastomotic leak.txt.txt (4.6 KB)
Target Clinical Description
An anastomotic leak is a severe postoperative complication that occurs when there is a failure in the integrity of a surgical connection between two segments of the gastrointestinal tract, specifically following colorectal surgery. Anastomotic dehiscence refers to the partial or complete separation of the surgically connected areas of the large and small intestine. This can lead to the release of intestinal contents into the peritoneal cavity, causing peritonitis, sepsis, and potentially life-threatening complications.
Presentation of Anastomotic Leaks
Common presentations for anastomotic leaks include:
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Fever -
Increased heart rate -
Abdominal pain or distension -
Changes in bowel movements -
Foul-smelling or purulent discharge from surgical site -
Leukocytosis
Some cases may present asymptomatically, only to be identified through postoperative imaging or during the investigation of other postoperative complications
.
Assessment for Anastomotic Leaks
- Abdominal imaging like CT scan with oral and IV contrast
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Blood tests including complete blood count and markers for infection -
Physical examination to assess surgical site and overall condition -
Laparoscopic or open exploration may be required for definitive diagnosis
Differential Diagnosis of Anastomotic Leaks
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Postoperative ileus -
Surgical site infection -
Bowel obstruction -
Hemorrhagic complications -
Non-specific postoperative ileus or abdominal discomfort
Treatment Plan for Anastomotic Leaks
Immediate management may require emergency surgical intervention to repair the leak and clean the peritoneal cavity. Drainage of abscesses and broad-spectrum antibiotics to manage sepsis are also crucial. In severe cases, diversion with an ostomy may be necessary.
Prognosis for Anastomotic Leaks
The prognosis for anastomotic leaks is highly variable and largely depends on the speed of diagnosis and effectiveness of treatment. A delayed or missed diagnosis significantly worsens the prognosis and increases the risk of systemic infection, multiple organ failure, and death. Early detection and appropriate management can lead to a more favorable outcome but may prolong hospital stay and recovery.
Assignment for Peer Review:
Peer review of the phenotype would be more than welcome