Spontaneous perforation of the colon. Resection with primary anastomosis or a staged (Hartmann) procedure

Whereas primary resection to remove the septic focus stands undisputed in t he therapy of spontaneous perforation of the colon, there is still no conse nsus as to whether to perform a primary anastomosis or a staged procedure ( Hartmann). Prospective randomized studies comparing both concepts are lacki ng. Obviously these two competing therapies fit different groups of patient s whose diseases differ concerning etiology, localisation and severity. Ana lysis of the literature of the past few years defined some criteria that he lp to decide when to omit primary anastomosis: MPI > 20, APACHE II score > 15, preoperative organ insufficiency, Hinchey grade III or IV and ASA score IV In these cases a discontinuity resection is recommended. Primary resect ion with anastomosis and Hartmann procedure are not competing operations bu t situation-dependent therapeutic concepts in spontaneous colonic perforati on.