A proactive technique for reversal of Hartmann's procedure: lifting the rectal stump to the abdominal wall

Reversing Hartmann's procedure is complicated owing to dense adhesions resulting from inflammation in the pelvic region. These adhesions pose challenges in identifying the rectum and increase the risk of pelvic organ injuries.

We propose a technique to lift and fix the rectal stump to the abdominal wall to diminish adhesions to the rectum and facilitate identification of the rectal stump.

The patient underwent Hartmann's procedure for generalized peritonitis resulting from perforation of the sigmoid colon. The abdominal cavity was significantly contaminated with fecal ascites, and postoperative pelvic adhesions were anticipated. Therefore, the rectal stump was lifted. The outcomes demonstrated that despite the presence of dense adhesions in the abdominal cavity, the rectal segment was promptly identified during the reversal of Hartmann's procedure. The procedure proceeded smoothly and was deemed satisfactory.

The technique of lifting and fixing the rectal stump to the abdominal wall is useful in cases where dense pelvic adhesions are anticipated during the subsequent reversal of Hartmann's procedure.