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Anastomotic leak — USMLE Step 3 MCQ

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HardSurgery (post-operative, follow-up)Anastomotic leakUSMLE Step 3

A patient five days after low anterior resection has fever, tachycardia, ileus, and CT evidence of extraluminal contrast beside the anastomosis. What is the best next management step?

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Correct answer: A — Resuscitate, give broad-spectrum antibiotics, and arrange urgent source control

Extraluminal contrast with systemic deterioration after colorectal anastomosis indicates an anastomotic leak. Immediate resuscitation, broad-spectrum antibiotics, and urgent surgical source-control assessment are required; imaging must not delay definitive escalation.

Reference: IDSA: 2024 Guideline Update on Complicated Intra-abdominal Infections: https://www.idsociety.org/practice-guideline/intra-abdominal-infections/