Abstract Management of anastomotic leak following colorectal reconstructive procedures is perhaps the most challenging issue facing both the patient and surgeon. These complications are frequently encountered in deconditioned and septic patients where clinical judgment and experience play a paramount role in the care of these patients. Several algorithms have been presented for evaluation and management of anastomotic leak based on location, chronicity, symptoms, locations, and diversion status. Timely management of anastomotic leak is paramount to minimizing short- and long-term morbidity and mortality in patients. With a varied armamentarium, and frequent need for multiple interventions, restoration of intestinal continuity and acceptable functional outcomes are achievable in a majority of instances.