Hyponatremia could identify patients with intrabdominal sepsis and anastomotic leak after colorectal surgery: a systematic review of the literature

Anastomotic leak (AL) is a serious post-operative complication in colorectal surgery. It can lead to devastating morbidity and mortality. Clinicians usually depend on a combination of clinical, biochemical and radiological findings to diagnose this problem. In our article, we tried to look if electrolyte disturbances could be indicators for intra-abdominal sepsis due to AL. Systematic review of the literature identifies a potential correlation between electrolyte alterations and AL in digestive surgery. The following databases were searched: PubMed, EMBASE and MIDLINE. The review adhered to the PRISMA statement for systematic review. Our literature search did not identify any articles linking any electrolyte disturbances—except for hyponatremia—to AL. Pathophysiology of these electrolyte disturbances does not seem to be linked to AL, except for hyponatremia which might be explained. Our review included 442 patients with intra-abdominal sepsis and 1133 controls. The mean specificity of hyponatremia being associated with intra-abdominal sepsis is 86%, whereas mean sensitivity is 28%. Hyponatremia seems to be a significant and clinically relevant marker for of intra-abdominal sepsis and AL.