Peroperative lavage of the obstructed left colon to allow safe primary anastomosis

Abstract

A series of 44 patients with complete or partial left-colon obstruction underwent laparotomy and intraoperative colonic lavage. Irrigation was unsuccessful in three, the operation being concluded by a Hartmann resection. In the remaining 41, the achievement of an empty colon allowed primary anastomosis after resection of the obstructing lesion. Seven patients (17.1 percent) died, none of dehiscence of the colorectal anastomosis, although minor anastomotic leaks occurred in four. The median postoperative hospital stay was 12 days. Two patients developed peritonitis (one fatal) from leakage of ileal contents when the irrigating catheter was introduced through an ileotomy and retained postoperatively, and this aspect of the technique is not recommended. The operation offers a single-stage alternative for patients with unprepared or ill-prepared bowels who require resection of left-colon lesions. The results compare favorably with the authors' previous experience of two- or three-stage resections (in-hospital mortality rate, 42 percent).