Background: Anastomotic leak is a dreaded complication of intestinal surgery and has been associated with a high mortality rate. There is a great deal of conflicting data regarding risk factors for anastomotic leakage, with most studies being small and looking only at anastomoses performed at one level of the gastrointestinal (GI) tract. The purpose of this study was to evaluate the possible predictive factors of anastomotic dehiscence in patients undergoing resection anastomotic operations at the levels of the small intestine. Objectives: The objective of this study was to identify risk factors associated with intestinal anastomotic leakage in order to practically assist in surgical decision making. Study Design: All adult patients having a small bowel resection with anastomosis at Kasr El-Aeini university hospital Surgical Emergency Department from July 2012 to January 2013 were enrolled in the study. Patients with a postoperative leak based on standardized criteria were identified. Patient characteristics, surgical procedure, and operating surgeon were noted. Overall complication and leak rates by surgeon were compared using Fisher’s exact test. Individual case review by a group of peers was performed for all patients with a leak who died, to determine the relationship to mortality. Data Sources: Medline plus (Pub Med ), control trials, review articles, prophetic (PBUH ) medicine and the Cochrane systemic review. Review authors were to independently evaluate the articles for inclusion criteria and quality, and abstract information for the outcomes of interest. Differences were to be resolved by consensus. The statistical methods were to include relative risk, risk difference, number needed to treat to benefit or number needed to treat to harm for dichotomous and weighed mean difference for continuous outcomes reported with 95% confidence intervals. Statistical presentation and analysis of the present study was conducted, using the mean, standard deviation and chi-square test by SPSS V.16. Difference was considered significant when probabilities of difference (P value) ˂0.05. Results: A total of fifty one emergency patients meeting the inclusion criteria underwent resection with anastomosis during the study period. There were 13/51 patients with leaks (25.4%),4 of whom died. In bivariate analysis, factors that were associated with anastomotic leaks were; advancing age, hypoalbuminemia (serum albumin <3(g/dl) 12/13 (92.3%), intra-operative hypovolaemia 8/13 (61.5%), intraoperative hypotension (systolic blood pressure below 80 mm Hg), diffuse peritonitis and low hemoglobin concentration (less than 10g %), all have a great association with anastomotic leakage. Mortality was significantly increased in patients with AL, we had 4 cases of mortality (3 males and 1 females), 4/51 (7.843%) of which had AL (3/13 – 23.07%) died in the postoperative period due to sepsis related multiorgan failure following anastomotic dehiscence. Conclusion: Multiple factors should be taken into consideration before and during emergency small intestinal resection anastomotic surgery to comprehensively assess the risk for AL and assessing preoperative comorbidities. The recognition of factors associated with anastomotic leakage after intestinal operations can assist surgeons in mitigating these risks in the preoperative period and guide intraoperative decisions. The variability in leak rate by surgeons doing similar operations suggests that many leaks may be preventable. But death after a leak is most often a surrogate for a critically ill patient and was infrequently the actual cause of death.