Surgery & Perioperative/GI / colorectal

Laparotomy & bowel resection

also: Hartmann · laparotomy · colectomy · stoma

Overview

Open abdominal surgery to resect bowel — for obstruction, perforation, ischaemia, or cancer.

Mechanism

Laparotomy with resection of the affected segment ± primary anastomosis or stoma formation (e.g. Hartmann procedure = sigmoid resection + end colostomy when anastomosis unsafe).

Indications

Bowel obstruction not settling / closed-loop / ischaemia
Perforation with peritonitis
Obstructing or perforated colorectal cancer
Toxic megacolon

The agents

Hartmann procedureresection + end colostomy

Perforated/obstructing sigmoid (e.g. diverticulitis, cancer).

Resection + primary anastomosis

When bowel healthy + patient stable.

Adverse effects

Anastomotic leakserious

Fever, peritonism, ↑inflammatory markers days post-op.

Stoma complicationscommon

Ileus, wound dehiscence, adhesionscommon

Cautions & contraindications

—all

Often emergency; resuscitate.

Choosing it

Distended abdomen, absolute constipation and vomiting (obstruction), or sudden severe pain with peritonism and free gas under the diaphragm (perforation).

Source: ACPGBI — Emergency laparotomy