Proximal colostomy: still an effective emergency measure in obstructing carcinoma of the large bowel.
Large bowel obstruction constitutes an emergency abdominal condition and necessitates prompt surgical treatment. The optimal approach is still controversial as to whether to perform a diverting colostomy only or a tumor resection with or without primary anastomosis. Seventy-one elderly and high-risk patients were treated by proximal diverting colostomy through a right upper abdominal incision. The operative mortality was 8.5%, with an additional morbidity of 20.5%. Stomal complications appeared in 6.1% of the survivors. Seventy-five percent of surviving patients underwent successful resection and closure of colostomy within 3 months without additional mortality. Others were not operated because of metastatic disease or severe concomitant disease. We conclude that although primary resection should be attempted in good risk patients, for those patients who are elderly and at high risk, a simple life-saving procedure, such as fecal diversion, could alleviate obstructions with relatively low morbidity and mortality and improve the patient's prospects for subsequent definitive surgery.
Gutman
M
M
Department of Surgery, Hadassah (Rokach) Hospital, Tel Aviv Medical Center, Israel.
Kaplan
O
O
Skornick
Y
Y
Greif
F
F
Kahn
P
P
Rozin
R R
RR
D000368:Aged; D000369:Aged, 80 and over; D003108:Colonic Diseases / Q000209:etiology / Q000601:surgery*; D003110:Colonic Neoplasms / Q000150:complications*; D003125:Colostomy / Q000379:methods*; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012307:Risk Factors