Naraynsingh Vijay, Maharaj Miranda, Rampersad Fidel S, Hassranah Samara C, Maharajh Sandeep
Clinical Surgical Sciences, The University of the West Indies, St. Augustine, TTO.
Surgery, Medical Associates Hospital, St. Joseph, TTO.
Cureus. 2024 Sep 2;16(9):e68473. doi: 10.7759/cureus.68473. eCollection 2024 Sep.
Initially, the Hartmann's procedure was done to reduce mortality in surgery cases of malignant rectal lesions, and not benign disease. However, the procedure was popularized in the management of perforated diverticular disease (PDD) in the 1970s. Herein, we present a case of a patient who had laparotomy and colostomy for PDD. During the post-operative planning for reversal of the diverting colostomy, a contrast study was done that revealed that most of the sigmoid colon was in fact healthy. In this patient, the colon was severed at the point of the perforation and exteriorized, which allowed time for the resolution of the gut inflammatory changes. Thus, Hartmann's operation would have led to the unnecessary resection of the healthy sigmoid colon and possibly condemned the patient to an irreversible stoma. In severe PDD, where a Hartmann's procedure is considered, one could sever the colon at the site of perforation and bring out a colostomy while tacking the closed, unresected distal end near the ostomy. Further contrast studies of the colon could assist in planning resection and anastomosis.
最初，哈特曼手术是为了降低恶性直肠病变手术病例的死亡率，而非用于良性疾病。然而，该手术在20世纪70年代因用于治疗穿孔性憩室病（PDD）而得以推广。在此，我们报告一例因PDD接受剖腹术和结肠造口术的患者。在术后计划回纳转流性结肠造口时，进行了一项造影检查，结果显示大部分乙状结肠实际上是健康的。在该患者中，结肠在穿孔处被切断并外置，这为肠道炎症变化的消退留出了时间。因此，哈特曼手术本会导致不必要地切除健康的乙状结肠，并可能使患者不得不接受不可逆转的造口。在考虑进行哈特曼手术的严重PDD病例中，可以在穿孔部位切断结肠并引出结肠造口，同时将封闭的、未切除的远端固定在造口附近。进一步的结肠造影检查有助于规划切除和吻合手术。
