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The \u2018traditional\u2019 three-stage procedure is marred by frequent failure to complete the planned sequence of operations and a resulting high permanent stoma rate. At each stage the mortality rate (7 per cent) and morbidity rate (30 per cent) are significant. The mortality rate following primary resection with delayed anastomosis (Hartmann's procedure) is 10 per cent. However, many patients experience complications and only 60 per cent have the stoma reversed. Primary anastomosis may be performed after subtotal or segmental colonic resection. The reported mortality rate is about 10 per cent with anastomotic leakage in 4\u20136 per cent, but cases are often carefully selected. It is difficult to suggest clear guidelines based on existing data. Although there are strong arguments in favour of a single-stage procedure, surgeons must decide whether available resources and local circumstances permit this. The alternative is Hartmann's procedure or referral to a surgeon with an interest in emergency colorectal surgery.<\/jats:p>","DOI":"10.1002\/bjs.1800810905","type":"journal-article","created":{"date-parts":[[2007,3,3]],"date-time":"2007-03-03T20:54:15Z","timestamp":1172955255000},"page":"1270-1276","source":"Crossref","is-referenced-by-count":417,"title":["Malignant obstruction of the left colon"],"prefix":"10.1093","volume":"81","author":[{"given":"G T","family":"Deans","sequence":"first","affiliation":[{"name":"Department of Surgery, Belfast City Hospital , Belfast,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Z H","family":"Krukowski","sequence":"additional","affiliation":[{"name":"Department of Surgery, Aberdeen Royal Infirmary , Aberdeen,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S T","family":"Irwin","sequence":"additional","affiliation":[{"name":"Department of Surgery, Belfast City Hospital , Belfast,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[1994,9,1]]},"reference":[{"key":"2024092815351494900_bib1","volume-title":"World Health Statistics Annual","author":"World Health Organization","year":"1989"},{"key":"2024092815351494900_bib2","doi-asserted-by":"crossref","first-page":"742","DOI":"10.1016\/0002-9610(82)90050-2","article-title":"Prognosis in patients with obstructing colorectal carcinoma","volume":"143","author":"Ohman","year":"1982","journal-title":"Am J Surg"},{"key":"2024092815351494900_bib3","doi-asserted-by":"crossref","first-page":"299","DOI":"10.1007\/BF02555634","article-title":"Survival in acute obstructing colorectal carcinoma","volume":"27","author":"Umpleby","year":"1984","journal-title":"Dis Colon Rectum"},{"key":"2024092815351494900_bib4","doi-asserted-by":"crossref","first-page":"296","DOI":"10.1002\/bjs.1800720417","article-title":"Malignant large bowel obstruction","volume":"72","author":"Phillips","year":"1985","journal-title":"Br J Surg"},{"key":"2024092815351494900_bib5","doi-asserted-by":"crossref","first-page":"904","DOI":"10.1016\/S0140-6736(86)90422-8","article-title":"Prediction of outcome after curative resection for large bowel cancer","volume":"ii","author":"Fielding","year":"1986","journal-title":"Lancet"},{"key":"2024092815351494900_bib6","doi-asserted-by":"crossref","first-page":"965","DOI":"10.1002\/bjs.1800760932","volume":"76","author":"Serpell","year":"1989","journal-title":"Br J Surg"},{"key":"2024092815351494900_bib7","first-page":"285","article-title":"Surgical treatment of acute intestinal obstruction caused by large bowel carcinoma","volume":"27","author":"Yu","year":"1989","journal-title":"Chung Hua Wai Ko Tsa Chih"},{"key":"2024092815351494900_bib8","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1002\/jso.2930450309","article-title":"Obstructing carcinoma of the cecum","volume":"45","author":"Rovito","year":"1990","journal-title":"J Surg Oncol"},{"key":"2024092815351494900_bib9","first-page":"257","article-title":"Surgical management of acute, malignant obstruction of the left colon with colostomy","volume":"4","author":"de Almeida","year":"1991","journal-title":"Acta Med Port"},{"key":"2024092815351494900_bib10","first-page":"67","article-title":"Obstructive colorectal carcinoma. 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