Primary resection and side-to-end anastomosis next to an end-colostomy in the management of acute malignant obstruction of the left bowel: an alternative in selected patients.
Tech Coloproctol
; 13(2): 123-6, 2009 Jun.
Article
em En
| MEDLINE
| ID: mdl-19484348
ABSTRACT
BACKGROUND:
Patients presenting with an acute obstructing carcinoma of the left bowel are a surgical challenge. Under more difficult circumstances with gross distension of the proximal colon many surgeons will decide to defer anastomosis. Hartmann's procedure still represents a valid treatment option. We describe our experience with primary resection and side-to-end anastomosis next to an end-colostomy in the management of acute malignant obstruction of the left bowel.METHODS:
The surgical procedure involves resection of the tumour and primary stapled side-to-end anastomosis next to a protecting end-colostomy. This type of enterostomy was first described by Santulli and Blanc in 1961. Colostomy closure is possible via a local procedure avoiding relaparotomy. Ten patients (five women) underwent surgery using this technique. Their mean age was 71 years (range 54-88 years). All patients had a massively distended colon. All obstructing lesions were biopsy-proven adenocarcinomas.RESULTS:
There was no postoperative mortality and no anastomotic leakage. The colostomy could be closed without a laparotomy in all patients. The only two complications were one superficial necrosis of the stoma and one wound infection after colostomy closure. In all other patients the postoperative course was uneventful. Wound infection after colostomy closure was seen in the very first patient in whom the wound was closed primarily. In subsequent patients the skin was left open.CONCLUSIONS:
The concept of an end-colostomy next to the anastomosis is an alternative approach combining the safety of proximal decompression and the advantages of primary anastomosis. This technique may be considered in patients presenting with a massively distended and faeces-loaded colon caused by an obstructing tumour in the descending or sigmoid colon, when the surgeon would otherwise elect to defer anastomosis.
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Carcinoma
/
Colostomia
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Neoplasias Colorretais
/
Colectomia
/
Obstrução Intestinal
Tipo de estudo:
Etiology_studies
/
Incidence_studies
/
Observational_studies
/
Risk_factors_studies
Limite:
Aged
/
Aged80
/
Female
/
Humans
/
Male
/
Middle aged
Idioma:
En
Revista:
Tech Coloproctol
Assunto da revista:
GASTROENTEROLOGIA
Ano de publicação:
2009
Tipo de documento:
Article
País de afiliação:
Holanda