When you think something is wrong – something IS wrong: Timely diagnosis of anastomotic leak

This chapter is focused on the timely diagnosis of anastomotic leak (AL). The general approach emphasizes the recognition of early symptoms of AL to expedite diagnosis and treatment. We will begin with a brief background on known risk factors for developing AL, followed by a review of common presenting symptoms and diagnostic tools. We will review clinical, laboratory, imaging, and endoscopic assessments that may be used to facilitate early diagnosis. We will discuss novel, evidence-based laboratory studies used to detect early AL. We will also discuss whether imaging studies are needed and the pros and cons of various imaging and endoscopic modalities for different types of AL. This chapter is intended to be a succinct reference to guide clinical practice.