outcome of one stage surgery in the practice of large bowel emergencies

In a consecutive series of 22 emergency admissions with large bowel disease during a period of 5 years, 13 were of colonic obstruction, 7 for peritonitis and 2 for mesenteric vascular occlusion, urgent operation was performed on all patients. Seventeen patients [77%] underwent immediate resection. An immediate anastomosis was performed in 11 [64.7%] patients. Of these, 2 had protective colostomy. Total group mortality was 18%, 11.8% in the immediate resection group, 9% in those with immediate anastomosis. Complications included an overall clinical anastomotic leak rate of 18%, but all were occurred in those without protective colostomy, intraperitoneal sepsis rate of 9% and wound infection rate of 22.7%. The results of this study suggest that primary resection in selected patients is safe. Immediate anastomosis after proximal colonic resections is feasible and safe, however, in distal colon, it is also safe provided that it is accompanied by protective colostomy