Immediate colectomy and primary anastomosis for acute obstruction due to carcinoma of the left colon and rectum.

A consecutive series of 35 patients with acute obstruction due to carcinoma of the left colon (29) or rectum (six) were treated by primary resection with anastomosis. The operation usually took the form of a left hemicolectomy or sigmoid resection without a proximal colostomy. There were three operative deaths (8.5 percent) due to anastomotic dehiscence, bronchopneumonia, and pulmonary embolism, respectively. Nonlethal complications occurred in ten patients (anastomotic leakage in three, a ureteric fistula in one, and wound infection in six). The mean duration of hospital stay in patients without complications was 18 days (range, 12 to 35). The morbidity and mortality in this series did not exceed the cumulative morbidity and mortality that would be expected after staged surgery. Compared with staged surgery, immediate resection and anastomosis, by avoiding the problems of colostomy and reducing the length of hospital stay, have significant advantages for the patient.