[Management of large bowel obstruction--own observation]

Large bowel obstruction is still a life threatening condition in spite of advances in surgical treatment and critically ill patients care. This study was designed to assess clinical and pathological features and results of surgical treatment for patients with large bowel obstruction.

We reviewed a series of 130 patients treated during a 17.5 years period at one institution.

Patients with large bowel obstruction accounted for 12.6% of 780 patients treated because of primary colorectal malignancy and 6.6% of 486 patients treated because of benign diseases of large bowel. Lesion causing obstruction was located in right half of colon in 43 (33.1%) patients (similarly in malignant and benign diseases: 33.6% vs. 31.2%) and in 73 (66.9%) patients in left colon. Primary resection of the lesion was performed in 110 (84.6%) patients and operation was completed with intestinal anastomosis in 73 (65.4%) of them. Hartmann's operation was the most common procedure in remaining 37 patients without bowel anastomosis performed. Perioperative complications occurred in 54 (41.5%) patients. Wound infection was the most often - 20 (15.3%) patients. Overall operative mortality was 13.8% (18 patients). Mortality was 5.5% in 73 patients with resection of the lesion and primary anastomosis performed, and 21.6% in 37 patients with resected lesion without primary anastomosis and 30% in 20 patients after non resective procedures.

Obstruction is a complication occurring two times more frequently in malignant than benign diseases of large bowel. We recommend radical surgery (resection and primary bowel anastomosis) in low risk patients (American Society of Anesthesiologists - ASA, I-II) independently of localisation of causing lesion and Hartmann's operation for high risk patients (ASA III-V).