Presentation
A case of transverse colon adenocarcinoma with gastric antrum invasion, who underwent extended right hemicolectomy and distal gastrectomy. Minimal abdominal tenderness and distension on the 7th post-op day without leukocytosis, fever, or tachycardia.
Patient Data
Evidence of recent surgery is seen as distal gastrectomy with Roux en Y reconstruction and extended right hemicolectomy with anastomosis of the ileum to the proximal descending colon, and two corrugated surgical drains. The amount of free intra-peritoneal air is more than expected for the 7th post-op day. Extra-luminal air bubbles are visible adjacent to the ileocolic anastomosis. The ingested oral contrast does not reach the ileocolic anastomosis, so the direct signs of anastomosis leak could not be evaluated. But regarding indirect signs, the anastomosis leak should be considered.
Case Discussion
The surgeon refuted the presence of a leak because of stable vital signs and a lack of leukocytosis. A few hours later, feculent discharge from the surgical drain was obvious, and the anastomotic leak was confirmed during surgery.