Table 2. Experimental evidence for a microbial cause of anastomotic leak.

• Isadore Cohn (Cohn and Rives) performs study in dogs in which direct application of antibiotics (via intraluminal catheter) to a devascularized (ischemic) colon anastomosis prevents leak 3

• Levine demonstrates that oral antibiotics administered to dogs for 6 days postoperatively increase colon anastomotic tensile strength by 70% 4

• Schardey et al demonstrates that contamination of an esophagogastric anastomosis in rats with Pseudomonas aeruginosa causes leak and is reversed with antibiotics 14

• Olivas demonstrates that P. aeruginosa causes anastomotic leak in the post radiated colon in rats via production of collagenase 34

• Shogan demonstrates that Enterococcus faecalis causes anastomotic leak rats via collagenase production and activation of anastomotic tissue MMP9 35