Abstract
Gastrointestinal (GI) leak is a well-known and catastrophic surgical complication. Its impact on patients, surgeons, and the healthcare system is tremendous. Efforts to constraint the occurrence and consequences of GI leak contributed to better assessment and management planning, especially with advanced technology. Detail information about the problem extent and new management options became available and effective for specific categories. Therefore, a full and accurate assessment and understanding of the disease presentation assists in choosing the appropriate management plan.The pathophysiologic process encompasses a severe inflammatory process with a superimposed infection inside sterile body tissue and cavities initiated by contaminated GI leaked content. The extent of the morbidity resulting from GI perforation and leak is variable and may not be predictable. Leak might not be the same in every case. Patients with GI leak present at variable severity depending on several factors. Accordingly, management should be individualized to target the underlying pathophysiology and the extent of the complication. Operative intervention and repair of the perforation site surgically or endoscopically are the standard of care frequently used. However, it may not always be needed. In this article, a practical review of the diversity and underlying pathologies of GI leak will be presented to inform case-specific management plans.
Highlights
BackgroundA leak of gastrointestinal (GI) content to the thoracic, abdominal, and pelvic cavities or retroperitoneal space is one of the most serious complications of GI diseases or surgical procedures
Understanding the condition in-depth may assist in improving our management planning and treatment outcomes
GI leak presents as a spectrum of severity or conditions
Summary
A leak of gastrointestinal (GI) content to the thoracic, abdominal, and pelvic cavities or retroperitoneal space is one of the most serious complications of GI diseases or surgical procedures. It affects the management plan and possibly the resulting complications This difference might not be that important because the consequence of leak is developing and have to be controlled and reversed. The current management practice focuses on identifying the presence of perforation and leak This necessitates surgical intervention for two main reasons: the primary one is to identify and seal the leak, and the secondary one is to ameliorate the consequences of the leak, such as the severe inflammation and infection that is done by washing and draining the leaked collection. A later attempt of operating or repair of bowel will not be technically possible due to the severe tissue inflammation and friability The exception of this situation is the controlled leak where the leaking contents are drained to outside the abdominal cavity by drains [20]. Leaning toward operative is a safe clinical treatment approach to GI leak in general
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