Emergency large bowel surgery: a 15-year audit

Object: To evaluate the management of patients presenting with colorectal emergencies. Method. Computerized audit of patients undergoing urgent/semiurgent surgery in the Colorectal Service, University Department of Surgery, Wellington School of Medicine, NZ. Results: 246 patients underwent major emergency or semi-emergency operations. Consultants performed 144 operations. The complications of cancer and diverticular disease were the commonest indications for surgery. Patients with inflammatory processes required significant perioperative nutrition. The disease site varied with the pathology. Overall the sigmoid colon was the commonest. Resection and anastomosis was generally performed for right-sided lesions whereas Hartmann's operation was the commonest procedure for more distally situated non neoplastic lesions. A loop diverting stoma was used most commonly in patients with obstructing cancer. The most frequent post-operative complication was urinary tract infection. Four patients developed pulmonary embolism, 2 ARDS, 4 myocardial infarction and 1 CVA. Persistent intra-abdominal sepsis requiring drainage occurred in five patients. There were 6 anastomotic leaks. 3 patients were re-operated upon to relieve post-operative small bowel obstruction. The overall post-operative mortality rate was 6.9%. Conclusion. A cautious policy of resecting right sided lesions and either diversion or resection without anastomosis for patients presenting acutely with left-sided colonic lesions resulted in a low overall mortality rate.