A 60-year-old woman undergoes anterior resection for rectal cancer. On post-operative day 5, she develops fever, tachycardia, and pelvic pain. Drain output is 400 mL of turbid fluid with a creatinine level matching serum. What is the most likely diagnosis?
- A Urinary fistula (anastomotic-ureteral communication)
- B Anastomotic leak with pelvic abscess ✓
- C Clostridioides difficile colitis
- D Intra-abdominal hemorrhage
Correct answer: B. Anastomotic leak with pelvic abscess
Explanation
Fever, tachycardia, pelvic pain, and turbid drain output on day 5 after anterior resection are classic for anastomotic leak with pelvic abscess, the most feared complication of low anterior resection. Drain creatinine matching serum rules out urine (urinary fistula would show markedly elevated creatinine in the fluid, typically many times serum level). Hemorrhage would produce bloody output. C. difficile causes diarrhoea, not pelvic pain with turbid drain fluid.
Reference: Bailey and Love's Short Practice of Surgery, 27th ed.
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