A 75yr old lady has an operation to remove a T3 adenocarcinoma from her sigmoid colon. CT 1 week later demonstrates a colostomy formed from her descending colon, and a blind ending rectal stump within the pelvis. Which operation has she had?
Abdominoperineal Resection (AP resection) | |
Anterior Resection | |
Sigmoid colectomy | |
Extended left hemicolectomy | |
Hartmann Procedure |
The Hartmann procedure involves resection of the rectosigmoid colon, with formation of a distal colostomy, and a rectal or colonic stump. This procedure is often performed instead of a primary anastamosis in patients who are at high risk of a leak. It allows time for the bowel to heal, before a ‘takedown’ is performed and the two ends of the bowel are anastomosed.
An AP resection involves removal of part of the sigmoid colon, the rectum and the anus, with formation of a permanent colostomy. An anterior resection involves resection of the recto-sigmoid colon, with anastomosis of the descending colon and rectum. A ‘low’ anterior resection involves resecting to a point further down the rectum. A sigmoid colectomy is where part or all of the sigmoid is removed, and the two ends are anastomosed. A left hemicolectomy is where the descending colon is removed and the transverse colon and sigmoid colon are anastomosed. The term ‘extended’ left and right hemicolectomy refer to where part of the transverse colon is also resected.
References
Multidetector CT of the Postoperative Colon: Review of Normal Appearances and Common Complications: http://pubs.rsna.org/doi/abs/10.1148/rg.332125723