Surgical management of large bowel obstruction

Acute colonic obstruction is a life threatening emergency. In this prospect ive study 69 patients suffering from large bowel obstruction, admitted betw een November 1993 and March 1998 to the University hospital of Bern, were a nalyzed with regard of the performed surgical procedure. The causes of obst ruction were colorectal carcinomas (38 %). other malignancies (19 %), volvu lus(13 %), hernias (10 %), diverticulitis (7 %) and others (13 %). 8 benign and 19 malignant lesions were surgically treated without colonic resection , the latter by colostomy (13), ileostomy (5) or bypass (1). All the other 42 patients had their obstruction resected within 24 hours after admission, 24 of them with primary anastomosis and 18 as a two-staged procedure. Howe ver, 9/18 (50 %) patients never have had restoration of bowel continuity. N o three-stage procedure was planned or performed. In-hospital mortality was 4/69 (5.8 %), all of them after staged resections due to non-surgical comp lications. No anastomotic leakage was clinically apparent, neither in one-s tage procedures, nor in completed two-stage procedures. Median length of to tal hospital stay in one-stage and two-stage procedures was 14 and 30 days, respectively. The advantages of one-stage procedures, especially in terms of subtotal colectomy, are discussed on the basis of an overview of the lit erature.