Emergency Subtotal Colectomy and Primary Ileo-Colic Anastomosis in the Management of Obstructing Carcinomoa of Left Colon

• Main Authors: Akhtar Munir, Ikramullah Khan
• Format: Article
• Language: English
• Published: Gomal Medical College, D.I.Khan, Pakistan 2010-12-01
• Series: Gomal Journal of Medical Sciences
• Online Access: http://gjms.com.pk/ojs24/index.php/gjms/article/view/255

Background: Carcinoma of left colon is a common cause of large bowel obstruction in elderly and middle aged population. This study was conducted to evaluate one stage operation i.e. emergency subtotal colectomy and primary ileo-colic or ileo-rectal anastomosis in the management of these patients. Methodology: This prospective study was conducted from January 2004 to December 2008 at DHQ Teaching Hospital D.I.Khan on patients with obstructing carcinomas of left colon. All patients underwent onestage procedure. Postoperative diarrhea was controlled with medication. Patients were referred to oncologist for adjuvant chemotherapy and followed at outpatient department. Results: During the study period, 28 patients, 18 males and 10 females, age range 23-69 years, with obstructing carcinoma of left colon were operated. Mean operative time was 112+31 minutes. Extent of subtotal colectomy and site of anastomosis were determined by the site of tumor. Ileo-descending colon anastomosis was performed in 2(7.15%), ileo-sigmoid 14(50%), and ileo-rectal in 12(42.8%) patients. Average hospital stay was 8 days. Postoperatively 3(10.7%) patients developed minor complications (wound infection and atelectasis) while 1(3.6%) developed anastomotic leak treated by re-operation. There was no perioperative mortality. All patients enjoyed normal diet and were stable with 1-3 bowel movements per day. During follow-up 3(10.7%) patients died of metastatic disease and 2(7.15%) of unrelated problems. Remaining 23 patients were alive and free of disease. Conclusion: Subtotal colectomy and ileocolic anastomosis (one stage procedure) should be considered as the treatment of choice for patients with obstructing carcinoma of left colon.