BACKGROUND Anastomotic leakage (AL) after restorative surgery for rectal cancer (RC) is associated with significant morbidity and mortality. AIM To ascertain the risk factors by examining cases of AL in rectal surgery in this retrospective cohort study. METHODS To identify risk factors for AL, a review of 583 patients who underwent rectal resection with a double-stapling colorectal anastomosis between January 2007 and January 2022 was performed. Clinical, demographic and operative features, intraoperative outcomes and oncological characteristics were evaluated. RESULTS The incidence of AL was 10.4%, with a mean time interval of 6.2 ± 2.1 d. Overall mortality was 0.8%. Mortality was higher in patients with AL (4.9%) than in patients without leak (0.4%, P = 0.009). Poor bowel preparation, blood transfusion, median age, prognostic nutritional index < 40 points, tumor diameter and intraoperative blood loss were identified as risk factors for AL. Location of anastomosis, number of stapler cartridges used to divide the rectum, diameter of circular stapler, level of vascular section, T and N status and stage of disease were also correlated to AL in our patients. The diverting ileostomy did not reduce the leak rate, while the use of the transanastomic tube significantly did. CONCLUSION Clinical, surgical and pathological factors are associated with an increased risk of AL. It adversely affects the morbidity and mortality of RC patients.

COVID-19 gastrointestinal manifestations could be attributed to SARS-CoV-2-induced small vessel thrombosis. OA with NPT treatment may have a role in optimization of bowel microcirculation and in the reduction of the endothelial and the systemic cytokine-related damage, improving also respiratory function.

Small bowel diverticulosis is a rare and acquired disease usually diagnosed as an incidental radiological finding. We report the case of a 65-year-old man admitted to our Emergency Department with abdominal pain and fever. The CT-scan showed multiple jejunal diverticular eversions and oedema of the surrounding tissues. At urgent laparotomy the radiological finding was confirmed with microperforation of one diverticula. Bowel resection was performed and histology revealed erosive inflammation with ischemic mucosa. Small bowel diverticula do not require any treatment if asymptomatic, nevertheless cases like this could be life-threatening. Urgent surgical procedure must be the treatment of choice in these patients.

PURPOSE Anastomotic leakage after restorative surgery for rectal cancer is associated with significant morbidity and mortality. Several factors have been identified as risk factors for anastomotic leakage. In this retrospective cohort study, we examined cases of anastomotic leakage in rectal surgery and tried to ascertain the risk factors. METHODS A review of 583 patients who underwent rectal resection with a double-stapling colorectal anastomosis between January 2007 and January 2022 was performed. Clinical, demographic and operative features, intraoperative outcomes and oncological characteristics were evaluated to identify risk factors for anastomotic leakage. RESULTS The overall incidence of anastomotic leakage was 10.4%, with a mean time interval of 6.2 +/-2.1 days. Overall mortality was 0.8%. Mortality was higher in patients with anastomotic leakage (4.9%) than in patients without leak (0.4%, P =0.009). Poor bowel preparation, blood transfusion, median age, prognostic nutritional index <40 points, tumour diameter and intraoperative blood loss were identified as risk factors for anastomotic leakage. Location of anastomosis, number of stapler cartridges used to divide the rectum, diameter of circular stapler, level of vascular section, T and N status and stage of disease were also correlated to anastomotic leakage in our patients. The diverting ileostomy did not reduce the leak rate, while the use of the transanastomic tube significantly did. CONCLUSION Clinical, surgical and pathological factors are associated with an increased risk of anastomotic leakage. It adversely affects the morbidity and mortality of rectal cancer patients.