Total colonic mobilization and exteriorization facilitates intra-operative colonic irrigation

Intraoperative colonic irrigation has become an accepted procedure in the management of left-sided bowel obstruction, making it possible to perform a safe primary anastomosis after resection. However, many surgeons raise objections to the technique because it is a complex procedure to perform on an acutely ill patient and, furthermore, the procedure is time consuming. A modification of the technique initially described by Dudley and his colleagues has already been reported from our hospital and utilizes an irrigation needle and a one-piece disposal sack. During irrigation, the colon requires to be manipulated to encourage the onward flow of faecal contents. Difficulty may be experienced because of the sharp angulation and fixity of the colon at both the hepatic and splenic flexures. Mobilization and exteriorization of the whole colon eliminates this problem.