Revisiting the value of dynamic assessment of postoperative C-reactive protein for early diagnosis of anastomotic fistulas in colorectal surgery with ileostomy.

Introduction: Anastomotic fistula is the most feared complication in colorectal surgery. It requires early diagnosis followed by urgent treatment. In this study, we analyzed the dynamics of C-reactive protein (CRP) as a marker for early detection of anastomotic fistula.

Methods: A prospective study was conducted among 83 patients who underwent colorectal resection with anastomosis at the First Surgical Department, County Emergency University Clinical Hospital, Cluj Napoca, Romania. The CRP and leukocyte values were recorded at admission and on postoperative days 3, 5, 7, and 9. Total serum protein values were measured on postoperative days 3, 5, and 7, and albumin values were measured on postoperative day 3.

Results: Only CRP values showed substantial postoperative variations. At postoperative days 3, 5, and 7, serum CRP levels in patients with anastomotic fistula were higher than those in patients without anastomotic fistula, with differences at postoperative days 5 (P <.001) and 7 (P <.001) being statistically significant.

Discussion: A steady decrease in CRP values after postoperative day 3 is a strong sign that the development of anastomotic fistula is unlikely. An increase or a flat decrease in CRP value at postoperative days 5 and 7 with a serum value at or close to 100 mg/L suggests an increased probability for development of anastomotic fistula.