CC BY-NC-ND 4.0 · Journal of Coloproctology 2020; 40(04): 386-389
DOI: 10.1016/j.jcol.2020.01.005
Case Report

Management of rectal stump leak following emergency Hartmann’s procedure

Gerenciamento do vazamento do coto retal após o procedimento de emergência de Hartmann
a  Nepean and Blue Mountains Local Health District, Department of Colorectal Surgery, Sydney, Australia
,
Penelope De Lacavalerie
a  Nepean and Blue Mountains Local Health District, Department of Colorectal Surgery, Sydney, Australia
b  University of New South Wales-Sydney, Conjoint Associate Lecturer South West Clinical School, Liverpool, Australia
› Author Affiliations

Abstract

We report on the management of three cases of rectal stump leak and sepsis following urgent Hartmann’s procedure for perforated sigmoid diverticulitis or large bowel obstruction. Two patients had significant risk factors for poor tissue healing. All patients developed features of sepsis and computer tomography scans demonstrated rectal stump leak with adjacent collections. All patients required reoperation for drainage and washout of abscess. An intraperitoneal catheter system was introduced together with drains in order to continue on the ward until tract was formed. There was no mortality and minimal morbidity. The key to management of rectal stump leak is the early and aggressive drainage of the associated collection and continued irrigation of the stump.

Resumo

Relatamos o tratamento de três casos de vazamento de coto retal e sepse após o procedimento de urgente de Hartmann para diverticulite sigmoide perfurada ou obstrução do intestino grosso. Dois pacientes apresentaram fatores de risco significativos para uma má cicatrização tecidual. Todos os pacientes desenvolveram características de sepse e tomografia computadorizada demonstraram vazamento de coto retal com coleções adjacentes. Todos os pacientes necessitaram de reoperação para drenagem e lavagem do abscesso. Um sistema de cateter intraperitoneal foi introduzido junto com os drenos para continuar na enfermaria até a formação do trato. Não houve mortalidade e morbidade mínima. A chave para o gerenciamento do vazamento de coto retal é a drenagem precoce e agressiva da coleta associada e a irrigação contínua do coto.



Publication History

Received: 14 October 2019

Accepted: 15 January 2020

Publication Date:
08 March 2021 (online)

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