The Hartmann Procedure for Complications of Diverticulitis

Nunes, Geoffrey C.; Robnett, Ausey H.; Kremer, Richard M.; Ahlquist, Richard E.

doi:10.1001/archsurg.1979.01370280079011

Cited by 35 publications

(12 citation statements)

References 16 publications

(2 reference statements)

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“…After the second stage postoperative morbidity and mortality were 31 and 3.9%, respectively, rates also comparable to these reported elsewhere [8,15,[19][20][21]. Reanastomosis was carried out without any great difficulty in most patients, due to an efficiently long inter val between the two stages (mean interval 3 months).…”

Section: Discussionsupporting

confidence: 86%

“…In cases with neoplasia, a perforated or obstructing sigmoid tumor was left in place until the second stage, whereas in cases with complicated diverticulitis the source of infection was not removed, occasionally with resultant enterocutaneous ab scess of fistula [8,9], Yet the total hospital stay was too long and the overall mortality rate was too high (6-44%) [8,10,II]. A colostomy usually performed in the first stage was not sufficient to decompress the bowel because the fecal content between the colostomy and the diseased segment of the bowel was drained caudally.…”

Section: Discussionmentioning

confidence: 99%

“…This complication can be prevented by closing the rectal stump with separate nonabsorbable stitches placed in the normal intestinal wall, well clear of the surrounding adipose tissue. Dilation of the anal sphincter after the operation has finished allows evacuation of the rectum and should reduce the risk of stump leakage [8]. Other authors report a higher frequency of pelvic abscess formation after the Hartmann procedure [15].…”

Section: Discussionmentioning

confidence: 99%

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Hartmann’s Procedure in the Treatment of Acute Colonic Conditions

Papachristodoulou¹,

Misiakos²,

Kouraklis³

et al. 1995

Dig Surg

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The aim of this study is to assess the safety of Hartmann’s procedure in the management of acute colonic conditions, in terms of postoperative morbidity and mortality associated with the two-stage procedure. Between 1975 and 1994, 80 patients underwent emergency Hartmann’s procedure in our department. Colonic obstruction and/or perforation due to carcinoma was present in 49 cases (61.2%) whereas the procedure was used for palliation in 9 cases (11.3%). Perforation due to diverticulitis was present in 19 cases (23.7%) and obstruction due to radiation enteritis was present in 3 cases (3.8%). Complications developed in 20 patients (morbidity rate: 25%). Eight patients (10%) died in the immediate postoperative period. Colorectal continuity was reestablished in 51 patients. Postoperative morbidity and mortality were 31 and 3.9%, respectively. In conclusion, Hartmann’s procedure is an optimal emergency procedure for complications of carcinoma or diverticulitis of the left colon and including subsequent restoration of bowel continuity has acceptable morbidity and mortality rates.

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Section: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Hartmann’s Procedure in the Treatment of Acute Colonic Conditions

Papachristodoulou¹,

Misiakos²,

Kouraklis³

et al. 1995

Dig Surg

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“…Many radiologists erroneously believe that the pouch consistsof a blind-ending rectal or rectosigmoid stump. In fact,theHartmann'spouchisdefinedin the surgical literature as a rectal or colonic stump that can extend as far proximally as the trans verse colon [I, 13,14]. In ourseries, the Hart mann's pouch extended beyond the level of the sigmoid colon in 14% of patients.The lengthof the pouchis of particularinterestto the surgeon because the stump can slowly shortenover time, affectingits locationin re lationto theproximaldivertingcolostomy [5]; this information is important when planning the surgical techniqueto takedownthecobs tomy and reanastomosethe proximal colon to thepouch.…”

Section: Radiography Of Hartmann's Pouchmentioning

confidence: 99%

Hartmann's pouch: radiographic evaluation of postoperative findings.

Cherukuri¹,

Levine²,

Maki³

et al. 1998

American Journal of Roentgenology

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OBJECTIVE. The purposeof this studywas to determinethe usefulnessof contrast-en hanced radiography of the Hartmann's pouch for evaluating postoperative abnormalities.MATERIALS AND METHODS. We performed a retrospectivestudy of 84 patients with a Hartmann's pouch who underwent contrast-enhanced radiography of the pouch during a recent 7-year period. Sixty-four patients underwent single-contrast barium studies of the pouch, 17 underwent studies with a water-soluble contrast medium, and three underwent both types of studies. The radiographic studies were reviewed to determine the types and fre quencyof abnormalitiesinvolvingthe pouch.Medical recordswere also reviewedto deter mine clinical presentation andcourse.RESULTS. Abnormalitiesof the Hartmann'spouchwere detectedon contrast-enhanced radiography in 16 (19%) of the 84 patients. Of the 70 patients who underwent routine con trast-enhanced radiography of the pouch, 11 (16%) had abnormalities, including diversion colitis in three,leaks in two, adhesionsin two, recurrentcarcinomain two, ulcerativecolitis involving the pouch in one, and a stricture in one. In both patients with clinically silent leaks, the contrast-enhanced radiography was performed 3 months or more after creation of the pouch. Of the remaining 14 patients who underwent contrast-enhanced radiography because of suspectedcomplications involving the pouch, five (36%) had abnormalities revealed, in cluding leaks in two, fistulas in two, and recurrent carcinoma in one.CONCLUSION. Contrast-enhanced radiographyof the Hartmann'spouchrevealedab normalitiesof thepouchin 19% of patients,includingleaksor fistulas,diversioncolitis,adhe sions, strictures, and recurrent tumor. Because two patients had clinically silent leaks that were detected during the late postoperative period, it may be prudent to perform these studies with a water-soluble contrast medium to avoid the problems associated with extravasation of barium into the extra-or intraperitoneal spaces.T he Hartmann's procedure is a common surgical procedure in which a temporarydiverting co lostomy and blind-ending rectal or colonic stump closed by suture (Hartmann's pouch) are created after partial colectomy or sig moidectomy [1]. This procedureis usually performed on an emergent basis in patients with complicated diverticulitis, obstructing or perforated sigmoid carcinoma, or pene trating trauma [2,3]. When such patients un dergo sigmoid resection, a Hartmann's procedure is performed rather than primary reanastomosis of the bowel because of the risk of anastomotic rupture associated with inadequate bowel preparation, complicating peritonitis,or both.The creationof a tempo rary diverting colostomy allows peritoneal inflammationto subside;the colostomycan then be taken down and reanastomosed to the pouch during the second stage of the proce dure to restore colonic continuity.Leakage or even blowout ofthe blind-end ing rectal or colonic stump can occur as a po tentially life-threatening complication of the Hartmann's procedure [4â€"7]. Other compli cations inc...

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“…Hartmann's procedure has also been extensively used in the treatment of acute complicated diverticular disease particularly as an alternative to a three stage procedure [4]. Hartmann's procedure was originally envisaged as being permanent; restoration of intestinal continuity has however been successfully achieved in many patients [5][6][7][8][9].…”

Section: Introductionmentioning

confidence: 99%