C-reactive protein (CRP) and leukocytes from peritoneal fluid – a role in predicting high digestive fistulas

Objective. Anastomotic fistulas in digestive surgery is a serious complication that can lead to patient’s death. The identification of paraclinical laboratory samples to al­low early diagnosis of fistulas would allow an optimal pa­tient’s management. Materials and method. We con­duc­ted a prospective study on 41 cancer patients ope­ra­ted for gastric tumors between 2016 and 2017 in the First Clinic of General Surgery and Oncology of the “Prof. Dr. Alexandru Trestioreanu” Institute of Oncology, Bucharest. All patients were subjected to gastric resections or gastrojejunal anastomoses. Therefore, digestive sutures were performed. Postoperative follow-up included the deter­mi­nation of C-reactive protein (CRP), monitoring of leu­ko­cyte counts in the peritoneal cavity (from a biological product harvested from the chest tube), associated with the number of leukocytes in the blood. Depending on the values of these biological samples and the clinical evo­lu­tion, other paraclinical investigations were used to confirm the diagnosis in selected cases. Results. The data obtained showed that patients with digestive fistulas had a rapid increase and maintained high values of CRP and leukocytes in the peritoneal cavity, which was associated with an increase in leukocytes’ blood count. Changes occur approximately two days prior to clinical signs and their confirmation by imaging (ultrasound, CT scan). Conclusion. Regular and standardized monitoring of CRP, leukocytes in the peritoneal cavity and leukocytosis on days 1, 3 and 5 allows the early identification of patients at risk for fistula and the rapid selection of patients requiring additional explorations and/or surgery.