Updates in Surgery

, Volume 71, Issue 1, pp 17–20 | Cite as

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

  • Ahmad Alsaleh
  • Gianluca Pellino
  • Natasha Christodoulides
  • George Malietzis
  • Christos KontovounisiosEmail author
Review Article


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.


Anastomotic leak Hyponatremia Electrolyte disturbance Colorectal surgery Complication 



The authors wish to thank the Royal Marsden Hospital Biomedical Research Council (BRC) for their support.


All Authors have no source of funding.

Compliance with ethical standards

Conflict of interest

The authors have no conflict of interest.

Research involving human participants and/or animals

This article did not involve human participants and/or animals.

Informed consent

No procedures were conducted by the authors on patients; there was no need of informed consent. This review was in agreement with the Good Clinical Practice.


  1. 1.
    Thomas MS, Margolin DA (2016) Management of colorectal anastomotic leak. Clin Colon Rectal Surg 29:138–144CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Kwon S, Morris A, Billingham R et al (2012) Routine leak testing in colorectal surgery in the surgical care and outcomes assessment program. Arch Surg 147:345–351CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Kaser SA, Nitsche U, Maak M, Michalski CW, Spath C, Muller TC et al (2014) Could hyponatremia be a marker of anastomotic leakage after colorectal surgery? A single center analysis of 1106 patients over 5 years. Langenbecks Arch Surg 399:783–788CrossRefPubMedGoogle Scholar
  4. 4.
    Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JP, Clarke M, Devereaux PJ, Kleijnen J, Moher D (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ 339:b2700CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Clowes GH, Vucinic M, Weidner MG (1966) Circulatory and metabolic alterations associated with survival or death in peritonitis: clinical analysis of 25 cases. Ann Surg 163:866–885CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Käser SA, Furler R, Evequoz DC, Maurer CA (2013) Hyponatremia is a specific marker of perforation in sigmoid diverticulitis or appendicitis in patients older than 50 years. Gastroenterol Res Pract 2013:462891CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Serradilla J, Bueno A, De la Torre C, Domínguez E, Sánchez A, Nava B, Álvarez M, López Santamaría M, Martínez L (2018) Predictive factors of gangrenous post-appendectomy intra-abdominal abscess. A case-control study. Cir Pediatr 31:25–28PubMedGoogle Scholar
  8. 8.
    Sciuto A, Merola G, De Palma GD et al (2018) Predictive factors for anastomotic leakage after laparoscopic colorectal surgery. World J Gastroenterol 24:2247–2260CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Pellino G, Frasson M, García-Granero A et al (2018) Predictors of complications and mortality following left colectomy with primary stapled anastomosis for cancer: results of a multicentric study with 1111 patients. Colorectal Dis 20:986–995CrossRefPubMedGoogle Scholar
  10. 10.
    Marres CCM, van de Ven AWH, Leijssen LGJ, Verbeek PCM, Bemelman WA, Buskens CJ (2017) Colorectal anastomotic leak: delay in reintervention after false-negative computed tomography scan is a reason for concern. Tech Coloproctol 21:709–714CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Swart RM, Hoorn EJ, Betjes MG et al (2011) Hyponatremia and inflammation: the emerging role of interleukin-6 in osmoregulation. Nephron Physiol 118:45–51CrossRefPubMedGoogle Scholar
  12. 12.
    Sharshar T, Blanchard A, Paillard M, Raphael JC, Gajdos P, Annane D (2003) Circulating vasopressin levels in septic shock. Crit Care Med 31:1752–1758CrossRefPubMedGoogle Scholar
  13. 13.
    Sartelli M, Griffiths EA, Nestori M (2015) The challenge of post-operative peritonitis after gastrointestinal surgery. Updates Surg 67:373–381CrossRefPubMedGoogle Scholar

Copyright information

© Italian Society of Surgery (SIC) 2019

Authors and Affiliations

  1. 1.Department of Colorectal SurgeryChelsea and Westminster HospitalLondonUK
  2. 2.Department of Medical, Surgical, Neurological, Metabolic and Ageing SciencesUniversitá della Campania “Luigi VanvitelliNaplesItaly
  3. 3.Department of Surgery and CancerImperial CollegeLondonUK

Personalised recommendations