A brave new world: Colorectal anastomosis in trauma, diverticulitis, peritonitis, and colonic obstruction

Many factors go into the decision to make an anastomosis in colorectal surgery. Emergency surgery is inherently higher risk than elective surgery, but patient factors, such as comorbidities and clinical status, and situational factors, such as contamination can increase the risk of anastomotic complications. Evidence has demonstrated the relative safety of anastomosis and diversion in the setting of feculent or purulent peritonitis, which is somewhat contradictory to previous surgical dictum. Anastomosis in the setting of large bowel obstruction has been extensively studied, and its safety varies widely depending on the cause of the obstruction, location of the obstruction and the type of anastomosis required. In traumatic injuries, data suggests that anastomosis is not necessarily riskier than diversion.