TY - JOUR
T1 - Surgical management of left colon obstruction
T2 - The University of Minnesota experience
AU - Deen, Kemal I.
AU - Madoff, Robert D
AU - Goldberg, Stanley M.
AU - Rothenberger, David A
N1 - Copyright:
Copyright 2007 Elsevier B.V., All rights reserved.
PY - 1998
Y1 - 1998
N2 - Background: Management of left-sided colonic obstruction is a surgical challenge. This study was performed to review our management of patients with left colon obstruction presenting to the University of Minnesota Hospitals over a 10-year period, 1985 to 1994. Study Design: We did a retrospective chart review of 143 patients (48 male and 95 female; mean age 70 years). Results: Sites of obstruction were rectosigmoid, 40%; sigmoid colon, 47%; descending colon, 5%; and splenic flexure, 8%. Fifty-two percent of patients had obstructing colorectal cancer. Two patients presented with generalized peritonitis secondary to colonic perforation. The majority (n = 121, 85%) of patients underwent resection (subtotal in 39 [32%], and segmental in 82 [68%]) and anastomosis in a single stage after appropriate resuscitation. Intraoperative colonic cleansing was undertaken in 40 patients (28%). Morbidity within 30 days of operation was 11%, including 1 anastomotic leak, and mortality was 3%. The 4 deaths occurred in patients over 75 years of age and were not from anastomotic complications. Conclusions: A single stage resection and an anastomosis facilitated by intraoperative colonic cleansing in one-third of cases was performed in 85% of patients presenting with left colon obstruction. One anastomotic leak occurred. Our current policy of strongly favoring a single stage, definitive operation for patients presenting with left colon obstruction appears reasonable on the basis of this retrospective review of our experience.
AB - Background: Management of left-sided colonic obstruction is a surgical challenge. This study was performed to review our management of patients with left colon obstruction presenting to the University of Minnesota Hospitals over a 10-year period, 1985 to 1994. Study Design: We did a retrospective chart review of 143 patients (48 male and 95 female; mean age 70 years). Results: Sites of obstruction were rectosigmoid, 40%; sigmoid colon, 47%; descending colon, 5%; and splenic flexure, 8%. Fifty-two percent of patients had obstructing colorectal cancer. Two patients presented with generalized peritonitis secondary to colonic perforation. The majority (n = 121, 85%) of patients underwent resection (subtotal in 39 [32%], and segmental in 82 [68%]) and anastomosis in a single stage after appropriate resuscitation. Intraoperative colonic cleansing was undertaken in 40 patients (28%). Morbidity within 30 days of operation was 11%, including 1 anastomotic leak, and mortality was 3%. The 4 deaths occurred in patients over 75 years of age and were not from anastomotic complications. Conclusions: A single stage resection and an anastomosis facilitated by intraoperative colonic cleansing in one-third of cases was performed in 85% of patients presenting with left colon obstruction. One anastomotic leak occurred. Our current policy of strongly favoring a single stage, definitive operation for patients presenting with left colon obstruction appears reasonable on the basis of this retrospective review of our experience.
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U2 - 10.1016/S1072-7515(98)00253-1
DO - 10.1016/S1072-7515(98)00253-1
M3 - Article
C2 - 9849728
AN - SCOPUS:0031737449
SN - 1072-7515
VL - 187
SP - 573
EP - 576
JO - Surgery Gynecology and Obstetrics
JF - Surgery Gynecology and Obstetrics
IS - 6
ER -