Management of left-sided colonic obstruction by subtotal colectomy and ileocolic anastomosis

Abstract

Objective: To assess complications and functional results of emergency subtotal colectomy with ileocolic anastomosis for acute left-sided colonic obstruction. Design: Retrospective study. Setting: University hospital, Netherlands. Subjects: 37 patients with acute left-sided colonic obstruction. Interventions: Emergency subtotal colectomy with immediate anastomosis (n = 20), Hartmann's procedure (n = 13) or double-loop transverse colostomy (n = 4). Main outcome measures: Mortality, morbidity, duration of hospital stay, frequency of defecation, and continence. Results: Morbidity after subtotal colectomy was 10% (n = 2) and mortality 0. There was one anastomotic dehiscence that required a temporary ileostomy. Mean hospital stay was 15 days (range 10-31). All had adequate continence. After 6 weeks mean frequency of defecation was 3/24 hrs (range 2-6). 9 patients died within 2 years of metastatic disease. Conclusions: Subtotal colectomy with ileocolic anastomosis is a suitable procedure for treating left-sided colonic obstruction provided that pelvic floor function is adequate and a skilled surgeon is available.