Akhtar Munir, Ikramullah Khan.
Emergency subtotal colectomy and primary ileo-colic anastomosis in the management of obstructing carcinoma of left colon.
Gomal J Med Sci Jan ;8(2):181-4.

Background: Carcinoma of left colon is a common cause of large bowel obstruction in elderly and middle aged population. This study was conducted to evaluate one stage operation i.e. emergency subtotal colec- tomy and primary ileo-colic or ileo-rectal anastomosis in the management of these patients. Methodology: This prospective study was conducted from January 2004 to December 2008 at DHQ Teach- ing Hospital D.I.Khan on patients with obstructing carcinomas of left colon. All patients underwent one- stage procedure. Postoperative diarrhea was controlled with medication. Patients were referred to oncolo- gist for adjuvant chemotherapy and followed at outpatient department. Results: During the study period, 28 patients, 18 males and 10 females, age range 23-69 years, with obstructing carcinoma of left colon were operated. Mean operative time was 112 +31 minutes. Extent of subtotal colectomy and site of anastomosis were determined by the site of tumor. Ileo-descending colon anastomosis was performed in 2(7.15%), ileo-sigmoid 14(50%), and ileo-rectal in 12(42.8%) patients. Aver- age hospital stay was 8 days. Postoperatively 3(10.7%) patients developed minor complications (wound infection and atelectasis) while 1(3.6%) developed anastomotic leak treated by re-operation. There was no perioperative mortality. All patients enjoyed normal diet and were stable with 1-3 bowel movements per day. During follow-up 3(10.7%) patients died of metastatic disease and 2(7.15%) of unrelated problems. Remain- ing 23 patients were alive and free of disease. Conclusion: Subtotal colectomy and ileocolic anastomosis (one stage procedure) should be considered as the treatment of choice for patients with obstructing carcinoma of left colon.

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