Evolution of surgery for large-intestinal obstruction

Summary

Since the early 1930s, it has been possible to distinguish clinically small- and large-intestinal obstructions. The hazard of perforation of the cecum in instances of complete colonic obstruction with great distention is today recognized by all abdominal surgeons. Decompression by transverse colostomy has been the operation of choice in this clinic. In this surgeon's judgment, primary resection is rarely justified. The patient deserves to be treated like a drowning man, dragged to shore. It is not the proper time for a swimming lesson.

The time may not be far off when the mortality rate associated with management of the acutely obstructed colon may approach minimal levels. The hospital mortality rate for decompression and subsequent resection of the colon for malignancy in this clinic over the 12-year interval 1942–1953 was 6.1 per cent; for cecal and sigmoidal volvulus, approximately 10 per cent. In 1943, this surgeon reported 61 primary consecutive colonic resections (unobstructed) with one death, a mortality rate of 1.6 per cent. These operations were performed over a two-year interval, all by the closed method of intestinal anastomosis, an enema being the only preoperative preparation.¹⁸ It is regrattable that this precise and nice method of anastomosis, effective and safe, has gone out of style.