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The suspended ileal loop for difficult Hartmann's reversal
P Fernoux1, E Delorme1, A Foote2
1Department of Surgery, Sainte-Marie Private Hospital, 71100, Chalon-Sur-Saône, France.
Background:
Hartmann's reversal can be complicated by the presence of dense adhesions in the upper part of the abdominal cavity, difficulties in freeing the splenic flexure with the risk of splenic tears, a lack of sufficient colonic length, the risk of ureteral lesion, or the risk of lesions of the vascular arcade.
Methods:
We propose a technique which consists of interposing an adapted segment of ileal loop between the end of the proximal colon and the rectum to restore intestinal continuity.
Results:
Two patients had Hartmann procedure, the first for a Hinchey stage 4 perforated diverticulitis and the second for a colorectal fistula due to ischemia of the proximal colonic segment. Hartmann's reversal was expected to be difficult, so a suspended ileal loop was used. The outcomes were uneventful, and functional results were satisfactory.
Conclusions:
A suspended ileal loop could be used as a salvage procedure in some cases of potentially difficult Hartmann's reversal.
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