Anastomotic Leak/Pelvic Abscess

Anastomotic leakage is a major postoperative complication following a low anterior resection of the rectum. Besides the immediate life-threatening risk, long-term problems include an anastomotic stricture and associated anorectal dysfunction, as well as possible increased risk for local recurrence. Among the many risk factors for the development of an anastomotic leak, the distance of the anastomosis from the anal verge is the factor most closely associated with its occurrence. Careful patient selection with thoughtful review of the individual patient risk factors has to be exercised when deciding to perform a protecting proximal diverting stoma at the time of the resection. A high index of suspicion both in the immediate and in the subsequent postoperative months is needed in order to detect a leak early and manage it promptly. Management is dictated by clinical presentation and severity of leakage.