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International Journal of Colorectal Disease
Published in: International Journal of Colorectal Disease 6/2006

01-09-2006 | Original Article

Emergency subtotal/total colectomy in the management of obstructed left colon carcinoma

Authors: Stéphanie Hennekinne-Mucci, Jean-Jacques Tuech, Olivier Bréhant, Emilie Lermite, Roberto Bergamaschi, Patrick Pessaux, Jean-Pierre Arnaud

Published in: International Journal of Colorectal Disease | Issue 6/2006

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Abstract

Purpose

The treatment of acutely obstructed carcinoma of the left colon still represents a matter of controversy. The aim of the study was to evaluate the results of its management by emergency subtotal or total colectomy with immediate anastomosis without diversion.

Methods

An emergency subtotal/total colectomy was performed in 72 patients (mean age 74.9 years). Inclusion criteria were reasonable operative risk, resectable acutely obstructed carcinoma, massively distended colon of dubious viability, and likely to contain ischemic lesions, signs of impending cecal perforation, and masses suggesting synchronous colonic cancers.

Results

Postoperative mortality was 9.7% (7 patients). An 83-year-old woman died as a result of an anastomotic dehiscence; the six other deaths resulted of cardiopulmonary complications. Postoperative morbidity was 15% (11 patients) including two fistulas, which recovered without surgery. There were eight synchronous colon carcinomas. Six months after surgery, the mean daily stool frequency was two following subtotal colectomy and three after total colectomy.

Conclusion

Emergency subtotal colectomy achieves in one-stage relief of bowel obstruction and tumor resection by encompassing a massively distended and fecal-loaded colon with ischemic lesions and serous tears on the cecum. It ensures restoration of gut contiguity via a “safe” ileocolonic anastomosis and removes occasional lesions proximal to the index cancer.
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Metadata
Title
Emergency subtotal/total colectomy in the management of obstructed left colon carcinoma
Authors
Stéphanie Hennekinne-Mucci
Jean-Jacques Tuech
Olivier Bréhant
Emilie Lermite
Roberto Bergamaschi
Patrick Pessaux
Jean-Pierre Arnaud
Publication date
01-09-2006
Publisher
Springer-Verlag
Published in
International Journal of Colorectal Disease / Issue 6/2006
Print ISSN: 0179-1958
Electronic ISSN: 1432-1262
DOI
https://doi.org/10.1007/s00384-005-0048-7

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