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A proctosigmoidectomy, Hartmann's operation or Hartmann's procedure is the surgical resection of the rectosigmoid colon with closure of the anorectal stump and formation of an end colostomy. It was used to treat colon cancer or inflammation (proctosigmoiditis, proctitis, diverticulitis, volvulus, etc.).
Risk factors include a birth defect known as intestinal malrotation, an enlarged colon, Hirschsprung disease, pregnancy, and abdominal adhesions. [1] Long term constipation and a high fiber diet may also increase the risk. [3] The most commonly affected part of the intestines in adults is the sigmoid colon with the cecum being second most ...
The first concepts of colon surgery were thought to have originated in the 15th century as a means to relieve obstructed bowel. The first reported ostomy, performed in 1776 by Pillore of Rouen as an attempt to circumvent blockage caused by a rectal tumor, was done at the insistence of the patient despite opposition from other doctors.
A colonic stricture is a band of scar tissue which forms as a result of the ischemic injury and narrows the lumen of the colon. Strictures are often treated observantly; they may heal spontaneously over 12–24 months.
The sigmoid colon is completely surrounded by peritoneum (and thus is not retroperitoneal), which forms a mesentery (sigmoid mesocolon), which diminishes in length from the center toward the ends of the loop, where it disappears, so that the loop is fixed at its junctions with the iliac colon and rectum, but enjoys a considerable range of movement in its central portion.
Best-suited for short (up to 7 centimeters) strictures, the H-M Strictureplasty is performed by making a cut lengthwise along one side of the bowel, pushing the two ends of the cut together and then suturing the bowel widthwise , thus, having the effect of widening the segment of narrowed bowel, therefore resolving the stricture.
During surgery anatomic defects in the sigmoid colon are sometimes observed in patients with ODS, such as acute bends which are stuck laterally (to one side of) or in front of the rectum. Many such defects may arise after hysterectomy because surgical adhesions in the pelvis may occur with scarring after the surgery.
Less commonly there may be ulcers in the anal canal or even in the sigmoid colon. [5] The nature of the tissue changes can vary from simple erythema (redness) / hyperaemia (increased blood flow) of the mucosa in 18% of cases, [1] to a chronic-appearing, small, shallow ulcer with nodular margins and a white or sloughing base.
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