[Left colonic cancer obstruction in Ivory Coast]

Abstract

Objective: This retrospective study comes forward to study our management of left colonic cancer obstruction by evaluating the mortality and the morbidity.

Patients and methods: From 1984 to 2001, 21 patients with left colonic cancer obstruction were treated in emergency. They were 12 males and 9 females with a mean age of 40.6 years. All the patients had complete clinical and radiological colonic obstruction. The pre-operative neoplastic origin of the obstruction was unknown in 20 cases. Six patients had hepatic metastases and 6 ovarian metastases. Six patients were classified as Asa II and 6 other Asa III. Nineteen patients (90.5%) underwent Hartmann's operation. The 2 remaining patients had immediate anastomosis after colectomy, with diverting ileostomy. These procedures were associated with hepatectomy in 5 cases and annexectomy in 6 cases. Intestinal continuity restoration was possible in 13 cases between 6 months and 1 year.

Results: Operative mortality was 9.5% (2 cases). Deaths were due to evisceration caused by parietal suppuration in one case and heart failure in the other case. There was no anastomotic fistula. Mean hospital stay was 14 days (12-21). Survival was 84% at one year and 0% at 5 years.

Conclusion: Our results suggest that Hartmann's operation is safe and may be usually performed in our conditions. However, near by amount colostomy and intra-operative colonic irrigation might be an alternating procedure in some selected patients.