الفهرس 
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Abstract
Postoperative intestinal fistulas are an important surgical complication, both in terms of the variety of their clinical manifestations, and in terms of the many factors that contribute to their occurrence. Many risk factors play a role in the cause of anastmotic leakage. The objective of this study was to study the patients who developed leakage after intestinal anastmosis, to detect these risk factors that led to that leakage. One hundred and Fourty Five (145) patients with intestinal anastmosis were subjected to this retrospective study at Mansoura University Hospitals, Mansoura Emergency Hospitals & colorectal surgical unit. Eighteen patients out of 145 developed leakage, that was presented by intestinal content in the drains or from the wound ,while others presented by abdominal pain or abdominal collection. The patients were followed regularly clinically by vital data (temperature, pulse), abdominal examination, laboratory by leucocytic count and serum albumin & radiologically by pelvi abdominal ultrasound and CT abdomen &pelvis. Evaluation of the results was based on the evaluation of the risk factors in each patient, as identifying these risk factors may help in prevention of leakage before performing an intestinal anastmosis. According to the results, the AL percentage was 12.4% for all cases, small intestinal leakage occurred in 6.2% of all anastmosis cases. Large intestinal leakage occurred in 4.1% of all anastmosis cases and ileocolic leakage occurred in 2.1% of all cases. The anastmosis was done either hand sewn (single layer -double layer - continuous -interrupted ) or stapled method ( linear cutter and circular stapler). According to AL patients, 6 patients developed low output fistula all of them were managed conservatively(NPO, Ryle tube ,Somatostatin, antibiotics, follow up by abdominal ultrasound for possibility of tube drainage for any collection) except one patient who was managed surgically due to burst abdomen. One patient of the low output type died after conservative treatment and after the fistula closed ,due to associated co-morbidities (hepatic, cardiac) being old aged (84 years old). Twelve patients developed high output fistula all of them were managed surgically in the form of diversion in 8 cases, re anastmosis in 3 cases except one patient who developed pulmonary embolism and died before surgery. Five patients out of those 12 high output fistula patients died after surgery, they were as follow : Two patients due to nutritional and electrolyte disturbance and surgical limitation in the form of short bowel syndrome and 1ry lesion near to the dudeno-jejenal flexure. Two patients due to co morbidities chronic liver disease (hepatic coma) sepsis, peritonitis and similar surgical limitation. The last patient was shocked came late to the hospital with associated multisystem organ failure. Conclusion: Male gender and chronic liver disease are major risk factors for anastmotic leakage. Resection is better than refashioning of intestinal fistula. Reconstruction is better at 3-6 months after diversion. Double layer manual anastmosis is better than single layer anastmosis. Diversion is better than anastmosis in some AL cases.