One-stage treatment of left-sided large bowel emergencies.

OBJECTIVE: To evaluate the safety and benefits of left-sided colectomy and primary anastomosis without intraoperative colonic irrigation in the management of patients with colorectal emergencies.

DESIGN: Prospective descriptive analysis of patients with emergency left-sided colonic and rectal lesions requiring resection and primary anastomosis. Setting A hospital based cohort over a five and a half year period at Jos University Teaching Hospital, Jos, Nigeria.

SUBJECTS: A total of 42 patients with left sided and rectal emergency lesions. Their ages ranged from 9-65 years with a mean of 43.1 years.

INTERVENTION: Twenty patients had sigmoid colectomy and primary colorectal anastomosis for sigmoid volvulus. Two patients with compound sigmoid volvulus had sigmoid colectomy as well as ileal resection and primary colorectal and ileoileal anastomosis. Transverse colectomy and primary colocolic anastomosis was carried out in six patients who had transverse colon tumour from gastric neoplasia. These six patients had in addition distal partial gastrectomy and gastrojejunal anastomosis to remove the primary gastric neoplasia. One patient had transverse colectomy and another four left hemicolectomy and primary colocolic anastomosis for trauma. Left colectomy and colocolic anastomosis was performed in three patients with left colon tumour while anterior resection and colorectal anastomosis for rectosigmoid cancer was carried out in six patients.

MAIN OUTCOME MEASURES: Manual decompression of the colon is as good as antegrade colonic irrigation in the management of left-sided large bowel emergency conditions in selected patients when undertaken by dedicated experienced surgeons.

RESULTS: There was one clinical anastomostic leak presenting as enteric fistula on the sixth postoperative day. The discharge was bilious and occurred in a patient with gastric mesenchymal stromal tumour who had distal partial gastrectomy and gastrojejunal anastomosis. He had no features of generalised peritonitis nor residual intra-abdominal abscesses. The fistula was managed non-operatively. A 12% wound infection rate was recorded. All infections were superficial and healed with conservative measures. We had no mortality in our series. The hospital stay ranged from 6 to 21 days with a mean of 7.5 days.

CONCLUSION: Manual decompression of the colon alone is as good as colonic irrigation in the management of left-sided large bowel emergencies. However, on-table antegrade colonic irrigation should be reserved for the loaded colon that may interfere with the use of a stapling instrument, when the resection margins are limited as in low anterior resections and when left-side colonic emergencies are undertaken by non-dedicated, less experienced surgeons.