The aim of this study was to evaluate the immediate and short-terme
follow-up results of one-stage subtotal or total colectorny and artastomosis
for patients with malignant Left colon obstruction. The study comprised
21 patients (10 males and 11 females) with age range of 36-81
years; presented by acute large bowel obstruction with clinical and radiological
evidence of obstruction. The choice of the extent of resection was
determined by the extent offecal load, the presence of colonic perforation,
serosal tears of the cecum and/or massive _colonic distension with concomitant
ischemio.; the presence of these features in a hemodynarnically
stable patient favored subtotal or total colectomy and ileo-colic or ileorectal
anastomosis . The site of obstruction was at the sigmoid colon in 9
patients (42.9%), rectosigmoicl in 8 patients (38.1%), splenic flexure in 3
patients (14.3%) and descending colon in one patient (4.7%). Ileosigmoid
anastomoses were done in 13 patients (61.9%) and 8 patients (38.1%)
had ileorectal anastomoses. The mean operative time was 201+33.2;
range: 150-270 minutes, the mean operative blood loss was
683.3+408.2; range: 250-1800 cc; 11 patients (45.8%) required blood
transfusion with a mean number of blood bags used was 2.8+1.2; 1-5
bags. Oral feeding was resumed after a mean period of 4.9+0.9; range: 4-
7 days and the mean postoperative hospital stay was 10+2.2; range: 8-
18 days. Overall, after 12-months follow-up only one patient had anastomotic
line recurrence with a recurrence rate of 4.75%, one patients died of
acute liver failure secondary to hepatic metastasis with mortality rate of
4.75% and 19 patients had follow-up free of morbidity with no local recur-rence or metastasis and a follow-up free rate of 90.5%. Thus, it could be
concluded that one-stage subtotal or total colectomy and ileo-colic or ileorectal
anastomosis are safe procedure with satisfactory outcome for management
of obstructing malignant lesions of the left colon. |
