[Emergency colonic surgery. Value of intervention in delayed emergency]

Currently, there is a trend towards emergency colectomy in patients requiring immediate care for lesions involving the large bowel. However, the therapeutic indications have not been fully identified. We therefore retrospectively evaluated our experience with 123 emergency situations.

Among 745 cases requiring colonic surgery from January 1985 to August 1992, 123 were seen in emergency for intestinal obstruction (n = 69; 56.1%), peritonitis (n = 41; 33.3%) or haemorrhage (n = 13; 10.6%). The mean age of the patient was 71 years and 50% were over 75. The left colon was involved in 76.4% of the cases. Diverticulitis was seen in 43.1% and 39% had cancer of the colon.

Emergency resection and anastomosis was performed in 55 cases (44.7%) without colostomy. In 62 patients (50.4%) a colostomy was created; 46 were later removed. In 61 cases, the patients underwent emergency surgery within 24 hours and in the other 62, delayed surgery was performed after one day of hospitalization. Overall hospital mortality was 11.4% (14/123), 20% for patients over 75 and 3.2% for those under 75. Mortality after delayed operations was lower (6.5%) than after emergency surgery (17.2%). There was also a higher rate of colon resections without colostomy in delayed procedures (62.9% vs 26.2%).

Our experience leads us to recommend delayed surgery whenever possible in order to decrease operative mortality and number of operations.