Neoplasms in long-term Hartmann's pouches

A Hartmann's pouch is a blind segment of the rectum created in conjunction with a colon resection in which primary bowel reanastomosis is judged unsafe. Often forgotten, this defunctionalized rectal pouch has a high potential of pathologic lesions, including disuse proctitis, ulcers, bleeding and occasionally neoplasm formation. What are the consequences of Hartmann's pouches left unattended? In this paper, we discuss three patients with neoplasms in a long-term Hartmann's pouch and the pathophysiology of the long-term defunctionalized rectum. We also question the possibility of increased incidences of neoplasms in long-term Hartmann's pouches. To monitor this we recommend close observation of the rectal pouch with proctoscopy and contrast studies.