Emergency large-bowel surgery in a tropical environment: approach and outcome

In 87 of 90 consecutive patients aged between 24 hours and 72 years operated upon for large bowel emergencies, 79.3% were for acute obstruction and 20.7% for perforation. Following a management policy of safety first, 46 (52.9%) patients had primary colonic resection with 25 (54.3%) of these primarily anastomosed (treatment group I), and 21 (45.7%) exteriorized (treatment group II). Twenty one (24.1%) patients with simple obstruction had reduction (treatment group III) and 27 others (31.0%) had colostomy alone after laparotomy (treatment group IV). In treatment group I, the mean hospital stay was 21 days, and the clinical leak rate was 8%. The mean hospital stay for treatment groups II-IV were, respectively, 36, 13, 69 days. There were nine (10%) deaths in hospital, six (6.9%) of these postoperatively, 11 (12.6%) septic complications and three (3.4%) wound failures in the series. The hazards of large bowel surgical emergencies can usually be minimised by primary resection, anastomotic integrity, avoidance of primary anastomosis or closure of laceration when hazardous and a judicious use of systemic and topical antibiotics in a well resuscitated patient.