A 50-year-old woman undergoes anterior resection for rectal cancer. On post-operative day 3, she develops fever, tachycardia, and pelvic pain. CT pelvis shows a 5 cm pelvic collection with air-fluid level at the anastomotic site. What is the most likely diagnosis?

• A Pelvic haematoma
• B Intra-abdominal abscess (non-anastomotic)
• C Anastomotic leak ✓
• D Clostridium difficile colitis

Explanation

Anastomotic leak after anterior resection typically presents on days 3-7 with fever, tachycardia, pelvic pain, and signs of sepsis. CT showing a collection with air-fluid level at the anastomotic site confirms the diagnosis. Pelvic haematoma would not typically show air-fluid levels. A. difficile causes diarrhoea. Non-anastomotic abscess would be remote from the suture line.

Reference: Bailey and Love's Short Practice of Surgery, 28th ed.

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