title: Advanced rectal cancer in a long-term Hartmann's pouch: a forgotten organ revisited.
abstract: Hartmann's procedure is widely performed as a first-stage operation in cases of left colon emergencies when a one stage management is judged to be unsafe. Forty per cent of patients with Hartmann's procedure never get their stoma reversed, ending with a permanent stoma. The distal excluded Hartmann's pouch is usually forgotten compared to the proximal functioning colon. A 70-year-old man with Hartmann's procedure carried out previously for complicated diverticular disease presented with bleeding per rectum. Invasive adenocarcinoma was confirmed on histology. Subsequent staging revealed a locally advanced rectal cancer. The tumour progressed despite a course of neoadjuvant chemoradiation. The general condition of the patient deteriorated with development of renal failure. The patient died a few weeks later. By reporting this case, we are revisiting the long forgotten Hartmann's pouch to highlight the potential pathologies in the distal stump and to emphasise that a distal stump should not be forgotten even in asymptomatic patients.
authors.affiliation: Department of Surgery, Sligo Regional Hospital, Sligo, Ireland.
authors.forename: Ahmed Mahmoud Abd El Aziz
authors.initials: AM
authors.lastname: Al Maksoud
authors.affiliation: Department of General Surgery, Sligo General Hospital, Sligo, Sligo, Ireland.
authors.forename: Iftikhar
authors.initials: I
authors.lastname: Ahmed
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology*; D000368:Aged; D003106:Colon / Q000473:pathology; D003125:Colostomy / Q000379:methods; D004239:Diverticulitis, Colonic / Q000601:surgery*; D017809:Fatal Outcome; D006801:Humans; D008297:Male; D011183:Postoperative Complications; D012004:Rectal Neoplasms / Q000473:pathology*; D012007:Rectum / Q000098:blood supply / Q000473:pathology*
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