INTRAOPERATIVE COLONIC IRRIGATION IN THE TREATMENT OF COLONIC EMERGENCIES - ABOUT 54 PATIENTS

The effects of on-table colonic irrigation followed by primary large b owel resection and anastomosis for emergency left colonic disease were prospectively studied in 54 patients. Patients and methods. Eighteen patients had a diverticular sigmoiditis complicated by localized (8) o r generalized (4) peritonitis, 6 presented a complete sigmoid obstruct ion, Thirty six patients had a left colonic occlusive (33) or perforat ed (3) cancer. Anterograde colonic irrigation was carried out with a m ean volume of 7.7 l. All patients received a double or triple antibiot ic combination. The anastomosis was handsewn in 33 cases and stapled ( Knight-Griffen) in 21. Seven patients with severe peritonitis had a pr oximal transitory stoma which was closed within 4 months. Results. Two patients (3.7 %) died postoperatively, one for anastomotic dehiscence and the second for evisceration. We observed 7 cases of hypothermia ( <34 degrees C) during the irrigation. Six patients developed a sepsis of the surgical wound, 2 a septicemia and 1 an abscess in the right il iac fossa which was percutaneously drained. All complications had a fa vourable outcome. Conclusion. This study confirms that in selected cas es a single stage surgery for colonic emergencies preceded by on-table irrigation grants good results and is a safe and effective alternativ e to Hartmann's procedure.