CRP (C-REACTIVE PROTEIN) In ColorectaL Anastomatic Leak and Sepsis: A Prospective Study

Abstract

Background: Anastomotic leak is defined as the presence of pus or enteric contents in the drains or presence of abdominal or pelvic collection in the areas of anastomosis on postoperative CT scan or leakage of contrast at the anastomotic site during an enema or evident anastomotic dehiscence at reoperation for postoperative peritonitis. Anastomotic leakage is one of the adverse events after colorectal surgery, which remains a significant burden for patients and surgeons. C-reactive protein (CRP) has proven to be a helpful parameter for detecting an anastomotic leak in colorectal surgeries.

 Methods: This prospective observational study was done in the Department of General And Minimal Invasive Surgery, Colorectal Division, at Sher-i-Kashmir Institute of Medical Sciences (SKIMS) Soura, Srinagar. This study included all patients >14 years of age undergoing elective colorectal surgery with primary colorectal anastomosis. Abstracted data included age at the time of surgery, sex (male or female), medical comorbidities (hypertension, diabetes, Hypothyroidism), preoperative chemo radiotherapy (received or not received), relationship CRP and anastomotic leak (AL) and management (reoperation, USG guided aspiration or CT showed pigtail drainage) of AL. CRP by latex-enhanced nephelometry was used in our study.

 Results: A total of 130 patients were included in our study. There were 75 (57.7%) males and 55 (42.3%) females with a mean age of 52.2 years. In our study, 17 (13.1%) patients received preoperative chemo radiotherapy, and 7 (41%) among them developed an anastomotic leak. In comparison, 113 (86.9%) patients did not receive any preoperative chemotherapy or radiotherapy, and 17 (15%) among them developed a leak. Out of 24 patients having an anastomotic leak, 7 (29.1%) patients had an anastomotic leak on the 3rd day, 10 (41.6% ) patients had an anastomotic leak on the 4th day, 5 (20.8%) patients had an anastomotic leak on the 5th day and 2 (8.3%) had an anastomotic leak on 6th day. Serum CRP level was significant in 26 cases and non-significant in 104 cases. Out of 26 patients with considerable serum CRP levels, 24 patients had an anastomotic leak. Among 24 patients who had an anastomotic leak, 5 (20.8%) patients were managed by reoperation in the form of peritoneal lavage and covering stoma (mostly ileostomy), and 19 (79.1%) were managed conservatively.