A person underwent laparotomy for Crohn’s disease with melena. A 15 cm segment of ileum was found to be diseased. Segmental resection with healthy margins and end-to-end anastomosis was done. On 7th postoperative day, the patient developed anastomotic leak. He continued to have 150-200 ml fistula output for the next 7 days. There was no collection of fluid in the abdomen and now patient is stable. The ideal management is:

**Core Concept**
The management of anastomotic leak after bowel surgery involves addressing the leak site, preventing infection, and maintaining bowel continuity. In this scenario, the patient's stable condition and absence of abdominal collection suggest a contained leak, which can be managed conservatively.

**Why the Correct Answer is Right**
The correct management for a contained anastomotic leak is conservative treatment, which includes bowel rest, intravenous fluids, antibiotics, and close monitoring. This approach allows the leak to heal on its own, reducing the risk of complications such as abscess formation, peritonitis, and fistula extension. The patient's stable condition and absence of abdominal collection suggest that the leak is contained, making conservative management the ideal approach.

**Why Each Wrong Option is Incorrect**
**Option A:** Surgical re-exploration would be considered in cases of uncontained leak, peritonitis, or failure of conservative management. In this scenario, the patient is stable and the leak is contained, making surgical re-exploration unnecessary.
**Option B:** Total parenteral nutrition (TPN) may be required in cases of bowel rest for an extended period but is not the primary management for a contained anastomotic leak.
**Option C:** Diversion of the bowel would be considered in cases of uncontained leak, peritonitis, or failure of conservative management. In this scenario, the patient is stable and the leak is contained, making diversion unnecessary.

**Clinical Pearl / High-Yield Fact**
A contained anastomotic leak is often characterized by a stable patient, absence of abdominal collection, and a fistula output of less than 200 ml/day. Conservative management is the ideal approach in such cases, with surgical re-exploration reserved for complications or failure of conservative management.

**Correct Answer:** D.

✓ Correct Answer: A. Continue conservative management and expect the fistula to heal