[Intraoperative anterograde lavage of the occluded left colon]

The management of patients presenting with acute organic obstruction of the left colon remains controversial. The traditional three stages procedure (transverse colostomy, resection and anastomosis, closure of colostomy) leads to a long and expensive postoperative hospital stay and to additional risks due to the multiple surgical treatments, despite involving a minor operation at the first stage. In selected patients, requiring emergency colonic resection, intraoperative antegrade colon lavage with primary anastomosis, as described by Dudley in 1983, represents a safe alternative to the stage procedure, achieving an excellent mechanical bowel toilette that allows a safe anastomosis and avoids the disadvantages associated with the multiple stages operations. During a 5 years period 13 large bowel resections with antegrade colonic irrigation and primary anastomosis were performed for acute left sided colonic obstruction requiring emergency surgery. The postoperative mortality rate was 0%; anastomosis leakage rate was 7.6% and would infections occurred in 7.6% of patients. The mean hospital stay was 15 days. Our results confirm that selected patients can be safely submitted to emergency colonic resection, on table lavage and primary anastomosis for acute left colonic obstruction without preoperative bowel preparation.