الفهرس 
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Abstract
Resection anastomosis of diseased small bowel segment is a
common surgical procedure in surgical units. This operation has a
wide range of indications such as inflammation, ischemia, traumatic
injury, obstruction, or malignancy.
AL is a frequent complication of intestinal surgery and has been
associated with postoperative morbidity and mortality.
In our study
Our present effort was prospectively conducted to clarify issues
relating to factors causing leakage with specific reference to
emergency surgeries related only to small intestinal surgeries, as all
cases we encountered requiring such an intervention are emergencies.
A total of 51 emergency patients meeting the inclusion criteria
underwent resection with anastomosis on emergency bases during the study period.
A total of fifty one emergency entero-enteric anastomoses
meeting the inclusion criteria were performed in the study period.
Complete history including age, sex and individual risk factors
were obtained from the accompanying clinical sheets.
General, local examinations and investigations were also
recorded. Patient were categorized; thirty three males (64.7%) and
eighteen females (35.2%).
Patients with traumatic injury represented 35.3% of the total;
studied sample, whereas those with diseased bowel represented 64.7%
of the total.
A total of 30 ileo-ileal (58.824%), 14 (27.451%) jejuno-jejunal
and 7 (13.725%) jejuno-ileal end to end anastomoses were constructed
in the study.
Our results suggest that irrespective of the primary pathological
process in the bowel, it is probably the associated secondary systemic
disturbances that occur in the emergent setting which lead to a state
conducive to anastomotic leakage. Hypoalbuminemia, preoperative
hemoglobin <10 gm/dl and intraoperative hypotension could well be a
few of these factors.
Intraoperative hypotension (systolic blood pressure below 80
mm Hg) 8/13 (61.5%) was found to be an independent risk factor for
anastomotic dehiscence by multivariate analysis in our study also post
operative ICU admission. Hypoalbuminemia (serum albumin <3g/dl)
was noted to be associated with anastomotic disruption 12/13 (92.3%) in our series..
In our study, diffuse peritonitis was associated with AL in 10
(76.9%) of the total patients included in the study. Low hemoglobin
concentration (less than 9g/dl %) was noted in 8 (61.5%) of the
patients with anastomotic dehiscence.
In our study, the effect of age or gender as a risk for AL, was
not significant.
In bivariate analysis, factors that were associated with AL were
hypoalbuminemia 12/13 (92.3%), intraoperative hypovolemia 8/13
(61.5%), intraoperative hypotension, diffuse peritonitis, and low
hemoglobin concentration.
There were13/51 (25.4%) patients with leaks ,four of them
died. Mortality was significantly increased in patients with AL as four (4/51, 7.8%) cases died; three (3/13, 23%) of them had AL.