ABSTRACT
Surgical intervention for colonic obstruction carries significant risks to the patient compounded by the risk of colonic perforation as the colon proximal to the point of obstruction distends. In the presence of a competent ileocecal valve, a ‘closed loop’ may lead eventually to gross cecal distension and, in extreme circumstances, cecal perforation. In patients with localized obstructing disease, the choice of surgical procedure is dependent on the position of the lesion. For right-sided colonic lesions, resection and construction of an ileocolic anastomosis is usual, whereas management of left-sided colonic lesions is more complex and often necessitates formation of an end colostomy after resection. Stamatakis et al.1 showed that 59 percent of patients who present with left-sided colonic obstruction had a successful one-stage surgical resection, while 41 percent underwent a Hartmann procedure. The reversibility of this stoma was variable. Patients with advanced malignant disease are often frail and surgical management may involve either a colonic bypass procedure, resection with stoma formation, formation of a stoma alone, or no procedure at all.
