Indicazioni attuali e tipologia della colostomia di protezione nelle urgenze coliche


Alfredo Wiel Marin, Andrea Di Giorgio, con la collaborazione di C. Destito, M. Mercuri, V. Ricciardi, F. Negro, S. De Fazio, T. Cozza

Ann. Ital. Chir., 2005; 76: 157-160

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BACKGROUND: A trend toward avoidance of a defunctioning colostomy at emergency large-bowel surgery has been placed
in recent years. The surgical management of patients with acute colonic disease has been evolving from multiple to single
operations with a reduced use of colostomy.
METHODS AND RESULTS: One hundred four consecutive non-selected patients underwent surgery for left-sided large bowel
emergencies between 1980-2003. Defunctioning colostomy was performed in 10 out of 58 resection-anastomosis procedures.
Thirty-seven patients underwent Hartmann procedure, 9 received only diverting colostomy. Postoperative morbidity
was 28.8%. Postoperative mortality 8.2%. Anastomotic leak occurred in 1 and 6 patients with and without defunctioning
colostomy respectively. Four out of the 6 patients without colostomy needed reintervention, while patient with covering
colostomy underwent conservative treatment. Six (10.5%) out 56 patients with colostomy experienced major stoma
related complications and underwent reintervention.
DISCUSSION: Although there is general acceptance of one-stage surgery for right-sided colon emergencies, the surgical management
of left-side large bowel obstruction and peritonitis remains controversal. Risk of anastomotic dehiscence associated
with large-bowel anastomosis in unfavourable circumstance must be balanced against the high complications and low
closure rates of a temporary colostomy.
CONCLUSION: Primary resection and anastomosis without diverting colostomy for left-sided acute obstruction and peritonitis
may be performed in selected patients. Diffuse purulent and faecal peritonitis are contraindications to one-stage surgery
being necessary a two- stage procedure with loop or end colostomy. Colostomy remain a valid surgical option when
high risk of dehiscence is suspected.


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