Malignant obstruction of the left colon
Article first published online: 6 DEC 2005
Copyright © 1994 British Journal of Surgery Society Ltd.
British Journal of Surgery
Volume 81, Issue 9, pages 1270–1276, September 1994
How to Cite
Deans, G. T., Krukowski, Z. H. and Irwin, S. T. (1994), Malignant obstruction of the left colon. Br J Surg, 81: 1270–1276. doi: 10.1002/bjs.1800810905
- Issue published online: 6 DEC 2005
- Article first published online: 6 DEC 2005
- Manuscript Accepted: 14 APR 1994
The management of malignant obstruction of the colon distal to the splenic flexure is controversial. The ‘traditional’ three-stage procedure is marred by frequent failure to complete the planned sequence of operations and a resulting high permanent stoma rate. At each stage the mortality rate (7 per cent) and morbidity rate (30 per cent) are significant. The mortality rate following primary resection with delayed anastomosis (Hartmann's procedure) is 10 per cent. However, many patients experience complications and only 60 per cent have the stoma reversed. Primary anastomosis may be performed after subtotal or segmental colonic resection. The reported mortality rate is about 10 per cent with anastomotic leakage in 4–6 per cent, but cases are often carefully selected. It is difficult to suggest clear guidelines based on existing data. Although there are strong arguments in favour of a single-stage procedure, surgeons must decide whether available resources and local circumstances permit this. The alternative is Hartmann's procedure or referral to a surgeon with an interest in emergency colorectal surgery.