Predictors of septic shock following gastrointestinal anastomotic leaks: Only signposts, no destination

Anastomotic leaks are associated with a high risk of morbidity and even mortality. Owing to this, surgeons have made considerable efforts to determine the clinico-biochemical factors that may help predict the development of anastomotic leaks or at least signal their development prior to their clinical manifestation (which usually precedes the development of septic shock if rapid action is not taken). Such parameters have been based on the markers of systemic inflammatory response syndrome (SIRS). The reason for making these efforts is the appreciation of the potential for rapid downward spiral (toward septic shock) once the anastomotic leak manifests clinically, and to thereby permit early detection which will aid the institution of effective measures, viz. “source control,” along with supportive measures such as fluid resuscitation and antimicrobials. The problem with such studies has been that surgery is in itself an insult that may be accompanied by SIRS, and hence, the factors studied tend to lack sensitivity.