Importance of C-Reactive Protein As A Clinical Diagnostic Tool For The Recognition of Anastomotic Leakage In Patients Undergoing Large Bowel Anastomosis

Tanweer Ahmed, Zakia Nehal, Imran Khan, Muhammad Mansoor Iqbal, Muhammad Iqbal Khan, Surghra Perveen

  • Tanweer Ahmed Department of Surgery, Ward 3 Jinnah Postgraduate Medical Centre Karachi



To determine the diagnostic importance of C-reactive protein (CRP) in prediction of anastomotic leak in subjects who underwent large bowel anastomosis with CT scan taken as a gold standard.

Study design

Cross sectional study.

Place & Duration of study

Department of Surgery, Unit I, Jinnah Postgraduate Medical Centre Karachi, from February 2017 to August 2017.


A total of 115 patients (both male and female) of age group 13-50 years who underwent large bowel anastomosis either electively or in emergency with minimum intra peritoneal contamination, were enrolled. Serum CRP values were acquired on postoperative day (POD) 5 and values >100 mg/L were considered indicative of anastomotic leak out. A CT scan was done for confirmation and occurrence of hyperdense region considered as an anastomotic leak.


Mean age of the subjects was 43.26 ┬▒8.01 year. Males were more commonly underwent surgery (n=73 - 63.5%) as compared to females (n=42 - 36.5%). Anastomotic leakage utilizing CRP was observed in 23 (20%) subjects. On the other hand 18 (15.7%) subjects were observed as an indicator of anastomotic leakage utilizing CT Scan. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and overall diagnostic accuracy were found as 61.11%, 87.63%, 47.83%, 92.39% and 83.47% respectively.


The diagnostic precision of C-reactive protein was found in recognition of anastomotic leak in patients with large bowel anastomosis considering CT scan as a gold standard.

Key words

C-reactive protein, Anastomotic leak, Bowel anastomosis.