Intraoperative colonic lavage and primary anastomosis in peritonitis and obstruction.
BACKGROUND
The surgical management of left colonic emergencies has evolved in the past few decades. Recently, there has been increasing interest in resection with primary anastomosis in selected cases. The aim of this study was to evaluate the differences in outcome in patients with peritonitis or obstruction treated by resection, on-table lavage and primary anastomosis of the left colon.


METHODS
Between January 1992 and August 1995, 212 patients underwent emergency operation for a distal colonic lesion: 97 presented with peritonitis, 113 with obstruction and two with other indications. Intraoperative colonic lavage was performed in 37 patients with obstruction and in 24 with an acute intra-abdominal inflammatory process.


RESULTS
The postoperative mortality rate was 5 per cent. The incidence of clinical anastomotic leakage was 5 per cent. Wound infection was observed in ten patients (16 per cent), more often in those with peritonitis (P = 0.03). The overall mean(s.d.) hospital stay was 15(9) days.


CONCLUSIONS
Resection, on-table lavage and primary anastomosis constitute the operation of choice for selected patients with left colonic emergency.
Biondo
S
S
Department of Surgery, Ciudad Sanitaria y Universitaria de Bellvitge, University of Barcelona, Spain.
Jaurrieta
E
E
Jorba
R
R
Moreno
P
P
Farran
L
L
Borobia
F
F
Bettonica
C
C
Poves
I
I
Ramos
E
E
Alcobendas
F
F
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical; D003108:Colonic Diseases / Q000601:surgery*; D004630:Emergencies; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000601:surgery*; D007430:Intraoperative Care; D008297:Male; D008875:Middle Aged; D010538:Peritonitis / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology*; D013529:Surgical Wound Dehiscence / Q000209:etiology; D013530:Surgical Wound Infection / Q000209:etiology; D007507:Therapeutic Irrigation; D016896:Treatment Outcome