[The value of peroperative colonic lavage in urgent colonic surgery. Apropos of 54 patients].
The effects of on-table colonic irrigation followed by primary large bowel resection and anastomosis for emergency left colonic disease were prospectively studied in 54 patients.


METHODS
Eighteen patients had a diverticular sigmoiditis complicated by localized (8) or generalized (4) peritonitis, 6 presented a complete sigmoid obstruction. Thirty six patients had a left colonic occlusive (33) or perforated (3) cancer. Anterograde colonic irrigation was carried out with a mean volume of 7.7 l. All patients received a double or triple antibiotic combination. The anastomosis was handsewn in 33 cases and stapled (Knight-Griffen) in 21. Seven patients with severe peritonitis had a proximal transitory stoma which was closed within 4 months.


RESULTS
Two patients (3.7%) died postoperatively, one for anastomotic dehiscence and the second for evisceration. We observed 7 cases of hypothermia (< 34 degrees C) during the irrigation. Six patients developed a sepsis of the surgical wound, 2 a septicemia and l an abscess in the right iliac fossa which was percutaneously drained. All complications had a favourable outcome.


CONCLUSIONS
This study confirms that in selected cases a single stage surgery for colonic emergencies preceded by on-table irrigation grants good results and is a safe and effective alternative to Hartmann's procedure.
Service de Chirurgie Générale et Digestive, CHU Hautepierre, Strasbourg.
C
C
Meyer
S
S
Rohr
A
A
Iderne
G
G
Tiberio
C
C
Bourtoul
D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000009:adverse effects; D000900:Anti-Bacterial Agents; D002423:Cause of Death; D003082:Colectomy / Q000009:adverse effects; D012809:Colon, Sigmoid / Q000601:surgery; D003110:Colonic Neoplasms / Q000150:complications / Q000601:surgery*; D003125:Colostomy; D004239:Diverticulitis, Colonic / Q000150:complications / Q000601:surgery*; D004359:Drug Therapy, Combination / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007035:Hypothermia / Q000209:etiology; D007415:Intestinal Obstruction / Q000209:etiology / Q000601:surgery; D007416:Intestinal Perforation / Q000209:etiology / Q000601:surgery; D007430:Intraoperative Care; D008297:Male; D008875:Middle Aged; D010538:Peritonitis / Q000209:etiology / Q000601:surgery; D011446:Prospective Studies; D012422:Rupture, Spontaneous; D012810:Sigmoid Diseases / Q000601:surgery*; D017792:Surgical Stapling; D013529:Surgical Wound Dehiscence / Q000209:etiology; D013530:Surgical Wound Infection / Q000209:etiology; D013536:Suture Techniques; D007507:Therapeutic Irrigation / Q000379:methods
D000900:Anti-Bacterial Agents
Intérêt du lavage colique per-opératoire dans la chirurgie colique d'urgence. A propos de 54 patients.