THE MANAGEMENT OF LEFT‐SIDED LARGE BOWEL OBSTRUCTION: AN AUDIT

Abstract

The outcomes of patients admitted acutely to hospital with left-sided large bowel obstruction (LBO) were examined. All patients admitted to the colorectal service (University Department of Surgery, Wellington School of Medicine) with LBO between 1975 and 1990 were reviewed. Sixty-four patients with left-sided LBO were identified. The most commonly found obstructing lesion was cancer. Two patients were not managed surgically. In 17.7% of patients there was development of postoperative respiratory complications and 16% developed wound problems following primary surgery. Fifty-nine patients survived their primary surgery and 45 had stomas. The stoma closure rate was 71.1% (32 of 45). The overall mortality rate for patients managed surgically was 6.5% (four of 62). The mortality rate for stoma formation was 4.3% (two of 47). The mortality rate for resection and then stoma closure was 3.2% (one of 32). This study has shown that a staged approach to the management of unselected patients with left-sided LBO is safe. Restoration of bowel continuity was achieved in 70% of patients.