[Treatment of acute obstruction due to left colonic cancer]

Retrospective study on 47 patients (23 men, 24 women); mean age was 70.2 years. The mean delay of complete obstruction was 6.95 days. There were associated pathology and clinical factors of gravity in 53.2%, and local factors of gravity in 43.9% of all cases. Three steps surgery in 22 cases (46.8%), two steps in 14 cases (29.7%): 6 "ideal" colectomies (12.7%), 5 colostomies alone (10.6%). Mortality: 3 patients died (6.8%), post operative complications occurred in 22 patients (46.8%); morbidity due to colostomies itself was 37.4%. All first step-colostomies, except one, has been closed after colectomy. The mean duration of total stays in hospital was 31.5 days, according with the surgical procedure in one (14.3 days), two (37.9 days) or three (43.2 days) steps. Duration of complete obstruction, bioclinical status of patients, staging and complications of the cancer and surgeon's experience are determining therapeutic choices. The choice for colostomy as first step is the best policy. In this series the mortality of the colostomy as first step was none. It must be performed with elective incision, on free colic segment (transverse or sigmoid), with the simplest technical procedure (loop colostomy). Others surgical procedures have only peculiar indications.