Anastomotic leak after bowel surgery: signs, treatment and recovery

When part of the bowel is removed, the surgeon usually joins the two healthy ends back together. This join is called an anastomosis. Dorset County Hospital explains that in an anterior resection, part or all of the rectum is removed and the two ends of healthy bowel are joined by stitching or stapling them together.

Sometimes the join does not heal completely and bowel contents leak out into the abdomen. This is an anastomotic leak. Cancer Research UK describes it as a leak where the ends of the colon are joined and says it is a serious problem needing treatment straight away.

Leaks are listed as a recognised risk of bowel surgery in patient leaflets, so surgeons discuss them during the consent process. Some operations are therefore planned with a temporary stoma to divert stool away from the join while it heals, as Dorset County Hospital describes.

North Bristol NHS Trust says that if there is a leak, you will probably experience a dull pain in your pelvis, the area below the belly button and above the hips, have a fever and feel lethargic. It lists anastomotic leak among the complications for which patients occasionally need re-admission after going home.

Cancer Research UK adds general signs of infection after surgery that deserve attention: a high temperature, shivering, feeling hot and cold, feeling generally unwell, feeling sick, loss of appetite, and swelling or redness around the wound. A leak can lead to infection inside the abdomen, so new or worsening pain, fever or feeling very unwell after bowel surgery should be reported at once.

• Worsening or new pain in the abdomen or pelvis.

• A high temperature, shivering or feeling hot and cold.

• Feeling generally unwell, very tired or sick, or loss of appetite.

• Tell your surgical team or use the emergency number you were given. Call 999 or go to A&E if you are very unwell.

The sources reviewed for this page do not list the individual risk factors for a leak. They describe it as a recognised risk of any operation that joins bowel, and note that the join is made in a body that is recovering from major surgery.

Dorset County Hospital advises getting as fit as possible before an operation, taking gentle exercise, eating a balanced diet and stopping smoking, and describes a temporary stoma as a way to divert stools away from the join while it heals.

The patient leaflets reviewed for this page describe the symptoms of a leak but do not set out the investigations in detail. In practice, clinicians assess your symptoms and may arrange examination, blood tests and imaging.

Because early signs can be vague, such as feeling generally unwell, teams encourage patients and carers to report any concern rather than wait.

Cancer Research UK lists treatment as stopping eating and drinking, antibiotics, a drain, and usually another operation. You might need more surgery to repair the leak if other treatments do not work, and this operation will usually involve a stoma.

Dorset County Hospital says that treatment with antibiotics and resting the bowel are generally enough in some cases, but that a leak can become a serious complication that needs further surgery and the formation of a stoma. The treatment depends on how large the leak is and how unwell the person is.

If you need a stoma, a specialist stoma nurse will help you learn to look after it. Cancer Research UK notes possible stoma problems such as skin irritation, leakage and dehydration from passing lots of poo through the stoma, and says barrier films, the right equipment and drinking well can help.

North Bristol NHS Trust says temporary stomas are created for a minimum of six weeks, that some are not reversed for several months depending on general health and recovery, and that around 1 in 12 patients who have a planned temporary stoma for cancer of the rectum will keep a permanent stoma. A leak or other complication can affect the timing of reversal, which your surgeon will discuss.

North Bristol NHS Trust notes that after surgery you are given contact numbers for who to call if you encounter any problems. Cancer Research UK says a leak needs treatment straight away, which is managed in hospital by the surgical team.

If your surgery was done privately, the same warning signs apply and you should use the emergency route given by your surgeon, with NHS A&E as the fallback if you cannot reach them. Ask in advance how complications would be managed and where.