Surgical procedures in colorectal cancer emergencies

About one third of the patients with colorectal cancer presents with large bowel obstruction, perforation or life threatening bleeding. In large bowel obstruction there is a trend towards primary resection and immediate anastomosis, also in cancer of the left colon. Among the techniques used are orthograde irrigation and primary resection with colo-colonic anastomosis, and in selected cases subtotal colectomy with ileosigmoid or ileorectal anastomosis. For sigmoid neoplasms causing obstruction immediate resection and end colostomy is recommended. In perforation at the tumour site, primary resection and immediate anastomosis may be justifiable if the peritonitis is localized. If diffuse peritonitis is present, primary resection with end colostomy seems to be the best choice. Although primary resection with or without immediate anastomosis has its merits, staged resection still remains a good and safe alternative in many cases.