Surgical management of left colon obstruction: the University of Minnesota experience.
BACKGROUND
Management of left-sided colonic obstruction is a surgical challenge. This study was performed to review our management of patients with left colon obstruction presenting to the University of Minnesota Hospitals over a 10-year period, 1985 to 1994.


METHODS
We did a retrospective chart review of 143 patients (48 male and 95 female; mean age 70 years).


RESULTS
Sites of obstruction were rectosigmoid, 40%; sigmoid colon, 47%; descending colon, 5%; and splenic flexure, 8%. Fifty-two percent of patients had obstructing colorectal cancer. Two patients presented with generalized peritonitis secondary to colonic perforation. The majority (n = 121, 85%) of patients underwent resection (subtotal in 39 [32%], and segmental in 82 [68%]) and anastomosis in a single stage after appropriate resuscitation. Intraoperative colonic cleansing was undertaken in 40 patients (28%). Morbidity within 30 days of operation was 11%, including 1 anastomotic leak, and mortality was 3%. The 4 deaths occurred in patients over 75 years of age and were not from anastomotic complications.


CONCLUSIONS
A single stage resection and an anastomosis facilitated by intraoperative colonic cleansing in one-third of cases was performed in 85% of patients presenting with left colon obstruction. One anastomotic leak occurred. Our current policy of strongly favoring a single stage, definitive operation for patients presenting with left colon obstruction appears reasonable on the basis of this retrospective review of our experience.
Deen
K I
KI
Department of Surgery, University of Minnesota Medical School, Minneapolis 55114, USA.
Madoff
R D
RD
Goldberg
S M
SM
Rothenberger
D A
DA
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical; D003108:Colonic Diseases / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D015179:Colorectal Neoplasms / Q000401:mortality / Q000601:surgery; D005260:Female; D006785:Hospitals, University; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D007416:Intestinal Perforation / Q000401:mortality / Q000601:surgery; D008297:Male; D008875:Middle Aged; D008910:Minnesota; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality / Q000601:surgery; D016737:Proctocolectomy, Restorative / Q000379:methods*; D012189:Retrospective Studies; D015996:Survival Rate