Operations for Colon Obstruction
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Many authorities report that it is safe to perform a primary resection with ileocolonic anastomosis for a mechanical obstruction of the right colon. Anastomosis of the obstructed small intestine is much safer than a similar anastomosis of the obstructed colon. If there is a large amount of stool in the transverse or left colon, however, primary anastomosis should be avoided. Anastomosis should also be deferred in patients who undergo emergency resection in the presence of advanced peritonitis. Such cases should be managed by resection accompanied by ileostomy and by exteriorization of the distal cut end of colon as a mucous fistula. Do not by any means perform a primary resection and anastomosis to treat obstructing lesions of the left colon. This operation has a much higher mortality rate than if preliminary colostomy were performed and followed by colon resection ten days later. The colostomy should be closed at a third operation. For perforated obstructing lesions of the left colon, perform an immediate resection with end colostomy and a mucous fistula.