ABSTRACT
Emergency colectomy is performed less frequently today than in the past with improved medical management of inflammatory bowel and other intestinal disease, but is still required for a variety of indications. The need for emergency colectomy for severe Clostridium difficile colitis is rising. Emergency colectomy can be performed either laparoscopically, by a laparoscope-assisted procedure, or by an open technique. The type of surgical approach depends upon the patient’s hemodynamic stability, the patient’s prior surgical history, the comfort level of the surgeon, and the degree of bowel distention. With significant bowel distention and loss of intra-abdominal domain, laparoscopic open surgery may be safer and more expedient in skilled hands. The importance for the patient of well-performed emergency surgery is brought into perspective by a recent report on emergency surgery in hospitals participating in the American College of Surgeons National Surgical Quality Improvement Program. Nearly 26 000 patients undergoing elective colorectal resection in this program had a morbidity rate of 23.9 percent and a mortality rate of 1.9 percent compared to just over 5000 patients who underwent emergent colorectal resection with a morbidity of 48 percent and mortality of 15.3 percent - nearly eight-fold that of the elective patients!1 Regardless of surgical approach, the principles are the same with respect to surgical indications, optimizing the patient’s condition for surgery, intraoperative patient management, technical tips to avoid complications following surgery, and postoperative patient care.
