The surgical management of obstruction and perforation of the left colon

Patients requiring emergency surgical treatment of the left side of the colon have a poor prognosis. Age, advanced malignant disease and systemic sepsis are contributory factors to the high morbidity and mortality rates, but making surgical decisions is also important. Any surgeon is likely to encounter only a few such patients per year and this adds to the uncertainty regarding management. Although the traditional three-staged approach was based on safety, it has been demonstrated that immediate resection is feasible and beneficial in most patients. This should be accompanied by primary anastomosis in all instances except in the presence of generalized peritonitis or a large abscess cavity causing severe systemic sepsis. When such circumstances occur, resection with terminal colostomy is the safest policy. We conclude that multicenter randomized prospective clinical trials should be initiated to establish the optimum and most economic method of resection and primary anastomosis for emergency operation of the left side of the colon.