Medical Oncologist
CION Cancer Clinics
Anastomotic leak after a gastrectomy: the signs and what happens next | CION Cancer Clinics
An anastomotic leak is a gap in the new join where the surgeon connected the gullet or the remaining stomach to the small bowel. Gut contents escape and the body reacts with fever, pain and a racing heart. It is uncommon but serious, and it is treated as an emergency. This page gives the warning signs first, then explains how a leak is found and treated. CION Cancer Clinics’ surgical oncologists in Hyderabad can talk this through with you.
MM
Medically reviewed by Dr. Muralidhar MuddusettyConsultant Surgical Oncologist · MBBS (AIIMS), MS (Surgery, AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh) · last reviewed September 2026, next review due September 2027
17+specialists on panel
15,000+patients treated
35+centres across Telangana & AP
4.8★ / 800+Google rating
The short answer
What is an anastomotic leak after a gastrectomy?
An anastomotic leak is a gap in the new join (the anastomosis) where the surgeon connected the gullet or the remaining stomach to the small bowel. Gut contents escape through that gap into the chest or the belly, and the body reacts with fever, pain and a racing heart. It is uncommon, but it is the most serious early complication of this operation and it is treated as an emergency.
Why a join can leak
The join is a ring of stitches or staples holding two pieces of gut together while they heal into one. Healing needs a good blood supply, no tension on the join, and a body with enough protein and no infection. Diabetes, smoking, low weight and a long operation all slow it. Sometimes a join leaks with none of these present. It is not caused by something you ate or did.
When it usually shows
Most leaks declare themselves in the first week or so, while you are still in hospital. A few show in the second week, sometimes after you have gone home. That is why the discharge advice tells you which symptoms to ring about, and why this page puts the warning signs first.
A leak is not the same as the drain putting out fluid. Drains put out fluid normally. What matters is a change in the colour, smell or amount, together with feeling unwell.
!
Go back to the hospital the same day if any of these happen
Fever or shivering in the first two weeks after a gastrectomy. New or worsening pain in the belly or chest, especially with a fast heartbeat or breathlessness. Cloudy, green, brown or foul-smelling fluid from the drain or the wound. Feeling suddenly very unwell, confused or faint. Do not wait for the morning, do not take a painkiller and see, and do not go to a local clinic first. Ring the number on your discharge sheet and say you have had a gastrectomy.
Not sure whether this applies to you?
Ask an oncologistWhat to watch for
How does a leak show itself?
A leak rarely announces itself with one dramatic sign. It is usually a person who was getting better and then, over hours, stops getting better.
Fever and a racing heart
The commonest early clue. The pulse climbs before the temperature does, which is why the nurses check it so often. A fever after this operation is never put down to a chest infection until a leak has been ruled out.
Pain that changes
Wound pain settles a little each day. Pain that comes back, spreads across the belly, reaches the shoulder tip, or makes breathing hurt is a different pain and needs to be reported.
The drain looks different
Clear or pale pink fluid is expected. Fluid that turns cloudy, green, brown, or smells foul may be gut contents, and the amount may rise. Some centres test the drain fluid for this reason.
Also tell the team about
- Fluid leaking from the wound itself
- A drain that suddenly stops after being active
Breathlessness and feeling unwell
After a total gastrectomy the join sits high in the chest, so a leak there can cause breathlessness, a cough, or fluid around the lung. Being suddenly worse, confused or unable to get out of bed is a sign in its own right.
If a leak is suspected
What happens once the team suspects a leak?
-
Nothing by mouth, and a drip
Eating and drinking stop at once so that nothing more passes through the gap. Fluids and antibiotics go through a drip. This is the first step whether or not a leak is later confirmed.
-
A scan to find the gap
Usually a CT scan after swallowing a dye, or an X-ray while swallowing it. The team is looking for where the dye escapes and whether a collection of fluid has formed. Sometimes a camera test (endoscopy) is used to look at the join directly.
-
Draining the collection
Many leaks are small and contained. A radiologist can place a thin tube through the skin, guided by the scan, to drain the fluid. Antibiotics continue. The join is given time to seal itself.
-
A stent or a clip from inside
For some leaks, a covered tube (stent) is placed across the join during an endoscopy so that food passes through the tube and not the gap. It is removed weeks later once the join has healed.
-
Going back to theatre
If the leak is large or you are very unwell, the surgeon operates again to wash out the belly or chest, place drains, and sometimes repair or redo the join. Nobody wants this option, and it is the right one when needed.
-
Feeding while it heals
Because you cannot eat by mouth, nutrition goes through a feeding tube into the small bowel below the join, or through a vein. Healing needs protein, and this is how it is supplied. Expect a longer stay than planned.
Leave a number, we will call you
One field. No form to fill in, and no charge for the call.
Commonly believed
Four things families tell us about leaks, and what is actually true
"He must have eaten something he should not have."
A leak is a failure of healing at the join, not a result of what went down it. Diet does not cause it. Families carry guilt over a spoonful of rice or a cup of tea, and that guilt is misplaced. Tell the team what was eaten because it helps them plan, not because it is anyone's fault.
"The surgeon made a mistake."
Leaks happen in the hands of every surgeon who does this operation, everywhere in the world. Skill lowers the chance but cannot remove it, because healing depends on the body as much as on the stitching. What matters most now is how quickly it is found and treated.
"A leak means the cancer treatment has failed."
A leak is a surgical complication. It has nothing to do with whether the cancer was removed. Once it has healed, the rest of the plan, including any chemotherapy, is picked up again. A delay of some weeks is usual and is planned for.
"We should take him home and manage the fever with tablets."
A fever in the first two weeks after a gastrectomy must be assumed to be a leak until a scan shows otherwise. Paracetamol hides the fever without treating the cause, and a leak that is treated a day late is far harder to manage. Go back the same day.
Being straight with you
What this page cannot tell you
It cannot tell you whether the symptoms in front of you are a leak, a chest infection, a wound infection or something else. Only a scan can, and the only safe response to any of the warning signs is to be seen. It cannot tell you how likely a leak is in your own case, or how long recovery will take if one happens.
What the team weighs before the operation
Surgeons lower the chance of a leak by building you up before the operation, correcting a low haemoglobin, controlling diabetes, asking you to stop smoking, and by the way the join is made. Ask your surgeon what your own risk factors are and what is being done about them.
Recovery after a leak
People do recover from leaks, including large ones, but it takes longer and often means weeks in hospital, a feeding tube, and a slower return to eating. Chemotherapy planned after surgery may be delayed until you are strong enough. Your oncologist will set that timing. None of this changes what the operation was for.
Keep the discharge sheet with the emergency number where the whole family can see it, and make sure the person driving knows which hospital to go to.Questions we are asked
Common questions about leaks after a gastrectomy
How common is a leak after a gastrectomy?
Uncommon, but not rare, and more likely after a total gastrectomy, where the join sits in the chest, than after a partial one. Published figures vary with the centre and the patient group, so ask your surgeon for their own experience rather than relying on a general number.
Can a leak happen after I have gone home?
Yes, though most show while you are still in hospital. A late leak usually appears in the second week as fever, new pain or feeling suddenly unwell. That is why you are given an emergency number at discharge. Use it the same day rather than waiting for the follow-up appointment.
Will I need another operation?
Not always. Many leaks are small and contained, and heal with antibiotics, a drain placed through the skin, or a stent placed from inside. A second operation is chosen when the leak is large, the person is very unwell, or the other methods are not working. Your surgeon will explain which applies.
How long does a leak take to heal?
It varies widely, from a couple of weeks for a small contained leak to considerably longer for a large one. Healing is checked with a repeat scan or dye test before eating restarts. Ask the team what they are looking for on that test.
How will I get nutrition if I cannot eat?
Through a feeding tube into the small bowel below the join, if one was placed at the operation, or through a drip into a large vein. Both supply the protein and calories healing needs. Neither is a step backwards.
Is a fever after discharge always a leak?
No. Chest infections, wound infections and urine infections all cause fever after surgery. But a leak is the one that cannot wait, so every fever in the first weeks is treated as a possible leak until a scan says otherwise. Being seen the same day is the safe response either way.
Will the leak delay my chemotherapy?
Usually yes, by some weeks, because chemotherapy needs a body that is healing and eating. Your oncologist will restart the plan once you are strong enough. Ask what the target is, so the delay feels like a plan.
Will the extra treatment be covered by Aarogyasri or insurance?
Treatment of a complication of a covered operation is usually included, but ceilings and pre-approval rules differ between Aarogyasri, CGHS, ECHS, EHS and private insurers. Ask the hospital's scheme desk early, and call the helpline if you need help understanding what your own cover allows.
Meet the Specialists
17+ senior cancer specialists. One panel for your case.
Trained at AIIMS, Tata Memorial, and leading international centres. Combined 150+ years of experience. Every complex case is reviewed by 3+ of them — together.
Medical Oncologist
Dr. C. Raghavendra Reddy
MBBS(Gold Medal), DNB(General Medicine), DM(Medical Oncology)(Gold Medal)
Medical Oncologist
Dr. Bharati Devi Gorantla
MBBS, MD(General Medicine), DM(Medical Oncology)(Adyar,Chennai), ECMO, MRCP SCE(UK)
Medical Oncologist
Dr. Owais Mohammed
MBBS, MD (General Medicine), DrNB (Medical Oncology), ECMO, MRCP SCE (Medical Oncology) (UK)
Medical Oncologist
Medical Oncologist
Surgical Oncologist
Dr. Muralidhar Muddusetty
MBBS (AIIMS), MS (Surgery) (AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh)
Surgical Oncologist
Surgical Oncologist
Surgical Oncologist
Dr. Vinay Mamidala
MBBS, MS(General Surgery), M.Ch(Surgical Oncology), FMAS, FARIS(Ongoing)
Surgical Oncologist
Radiation Oncologist
Radiation Oncologist
Radiation Oncologist
Hematologist
Surgical Oncologist
Dr. Vajja Sandeep Kumar
MBBS, MS (General Surgery), DrNB (Surgical Oncology), FALS Oncology
Surgical Oncologist
Want a specific doctor for your case? Mention them when booking.
Book Free ConsultationBook an appointment with our specialist
Share your name and number — we'll call you back within 30 minutes to schedule your consultation.
Patient stories
Hear it from people we have treated
Every story is a video, in the patient's own words. Nothing here is a written testimonial.
Where to find us
Our centres in and around Hyderabad
Addressed by landmark, because that is how this city navigates. A surgical consultation can be booked at any of these centres through one helpline, and your team will tell you where the operation itself takes place.
Warangal
Vizag
Sources
- Macmillan Cancer Support — Surgery for stomach cancer
- Cancer Research UK — Surgery for stomach cancer
- American Cancer Society — Surgery for stomach cancer
- National Cancer Institute — Gastric cancer treatment (PDQ)
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
Keep reading
Related pages
Complications and Red FlagsThe full list of what to ring about after any cancer operationFeeding Jejunostomy After Stomach SurgeryHow you are fed while a join healsRoux-en-Y and Other ReconstructionsWhere the join sits and how it is madeICU and the First Days After SurgeryWhat the first week in hospital normally looks like
Talk to us
Worried about a symptom after stomach surgery?
If it is one of the warning signs on this page, go to the hospital now. For everything else, send us the discharge summary and tell us what has changed. One helpline serves every CION centre.