In Hartmann's procedure performed for obstructed sigmoid colon cancer, what defines the anatomical basis for the subsequent reversal procedure (Hartmann's reversal)?

• A End ileostomy with sigmoid colon in situ
• B Loop colostomy with defunctioned distal sigmoid colon
• C Abdominoperineal resection with permanent colostomy
• D End colostomy at left iliac fossa with oversewn rectal stump preserved in pelvis ✓

Explanation

Hartmann's procedure creates an end colostomy at the left iliac fossa from the proximal colon after resecting the diseased sigmoid segment, while the distal rectum is oversewn and left as a 'Hartmann's pouch' or rectal stump within the pelvis. Reversal involves identifying the rectal stump and creating a colorectal anastomosis to restore bowel continuity—technically demanding due to adhesions. A loop colostomy differs in leaving the bowel in continuity. APR involves permanent colostomy with resection of the rectum and anus.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

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Written and medically reviewed by the StethoPrep medical team.