A 68-year-old man presents with acute large bowel obstruction. CT scan shows an annular, obstructing carcinoma in the descending colon with proximal colonic dilation but no evidence of perforation or peritonitis. He is hemodynamically stable. What is the most appropriate surgical management?
- A Primary resection of the tumor with on-table lavage and primary anastomosis ✓
- B Hartmann's procedure with end colostomy and mucous fistula
- C Emergency right hemicolectomy with primary anastomosis
- D Diverting loop transverse colostomy to relieve the obstruction
Correct answer: A. Primary resection of the tumor with on-table lavage and primary anastomosis
Explanation
For a fit, stable patient with a malignant left-sided large bowel obstruction without perforation or peritonitis, the standard of care is primary resection with on-table colonic lavage and primary anastomosis. This avoids the morbidity of a permanent stoma and the high leak rate of an unprepared primary anastomosis. Hartmann's is reserved for unstable patients or those with feculent peritonitis. C diverting colostomy is a palliative option for unresectable disease.
Reference: Bailey and Love's Short Practice of Surgery, 27th ed.
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Written and medically reviewed by the StethoPrep medical team.