Ileus due to a colorectal carcinoma is still an illness with high mortality currently between 15 and 20%. Advanced tumor stages are found in the majority of the patients. Today one-staged procedures are preferred, although a clear advantage in postoperative mortality was not proven so far. We recommend a concept, depending on localization, general condition and tumor stage. For patients in very bad general condition a primary colostomy is still a good option today. In case of a damaged intestine we recommend either a two-staged procedure with primary resection and colostomy and secondary closure of the stoma or a subtotal colectomy in patients who are in a good general condition. For patients in very good condition an one-staged procedure should be performed, whereby we prefer the resection with on table lavage.