Hartmann’s rectal stump revisited preoperative evaluation prior to reversal

Jordan Ari Munger; Nir Horesh; Steven Naymagon; Joel J. Bauer

doi:10.18203/2349-2902.isj20175416

Authors

Jordan Ari Munger Department of Surgery, Mount Sinai Medical Center, New York, NY, USA
Nir Horesh Department of Surgery, Mount Sinai Medical Center, New York, NY, USA
Steven Naymagon Department of Medicine and The Division of Gastroenterology, Mount Sinai Medical Center, New York, NY, USA
Joel J. Bauer Department of Surgery, Mount Sinai Medical Center, New York, NY, USA

DOI:

https://doi.org/10.18203/2349-2902.isj20175416

Keywords:

Barium enema, Hartmann’s reversal, Endoscopy, Rectal stricture

Abstract

Hartmann’s procedure is the gold standard surgical intervention in a variety of emergencies. Hartmann's Reversal is a complex procedure and has high rates of intra-operative and post-operative complications. There are no clear guidelines or recommendations for pre-operative evaluation of the remnant colorectal pouch prior to restoration of intestinal continuity. We present two patients who underwent Hartmann reversal. In both cases, during pre-operative endoscopic evaluation of the Hartmann colorectal pouch, a stricture was incorrectly thought to be the pouch’s blind end and the anastomosis was formed proximal to that stricture. In case 1, a partial obstruction developed that was successfully treated with endoscopic balloon dilatation. In case 2, a complete obstruction occurred, requiring emergent re-operation with formation of a bypass around the stricture. Surgeons and gastroenterologists should be aware of this diagnostic pitfall, and consider pre-operative evaluation that includes both endoscopic and radiologic evaluation in patients being considered for reversal.

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References

Sanderson ER. Henri Hartmann and the Hartmann operation. Archives Surg. 1980;115(6):792-3.

Hotouras A. Henri Hartmann and his operation. Grand Rounds. 2008;8:L1-3.

Hartmann H. A new method for the removal of cancers from the terminal part of the pelvic colon. In Trentieme Congress of Surgery. 1921;28:411.

Al AM, Ahmed I. Advanced rectal cancer in a long-term Hartmann's pouch: a forgotten organ revisited. BMJ Case Reports. 2016;2016:bcr2015213405.

Jamali FR, Soweid AM, Dimassi H, Bailey C, Leroy J, Marescaux J. Evaluating the degree of difficulty of laparoscopic colorectal surgery. Archives of Surgery. 2008;143(8):762-7.

Haas PA, Fox TA. The fate of the forgotten rectal pouch after Hartmann's procedure without reconstruction. The American Journal of Surgery. 1990;159(1):106-11.

Al AM, Ahmed I. Advanced rectal cancer in a long-term Hartmann's pouch: a forgotten organ revisited. BMJ Case Reports. 2016;2016:bcr2015213405.

Lafreniere R, Ketcham AS. Hartmann's pouch carcinoma. J Surgical Oncol. 1985;29(1):26-7.

Thaemert BC, Kisken WA. Neoplasms in long-term Hartmann's pouches. Wisconsin medical journal. 1996;95(2):105-7.

Zbar AP. Reconstructive surgery of the rectum, anus and perineum. Madoff RD, Wexner SD, editors. Springer; 2013.

Cherukuri R, Levine MS, Maki DD, Rubesin SE, Laufer I, Rosato EF. Hartmann's pouch: radiographic evaluation of postoperative findings. AJR. Am J Roentgenol. 1998;171(6):1577-82.

Ballian N, Zarebczan B, Munoz A, Harms B, Heise CP, Foley EF, et al. Routine evaluation of the distal colon remnant before Hartmann’s reversal is not necessary in asymptomatic patients. Journal of Gastrointestinal Surgery. 2009;13(12):2260.

Ragg J, Garimella V, Cast J, Hunter IA, Hartley JE. Balloon dilatation of benign rectal anastomotic strictures-a review. Digestive Surgery. 2012;29(4):287-91.

Keck JO, Collopy BT, Ryan PJ, Fink R, Mackay JR, Woods RJ. Reversal of Hartmann's procedure: effect of timing and technique on ease and safety. Diseases Colon Rectum. 1994;37(3):243-8.

Khan AL, Ah-See AK, Crofts TJ, Heys SD, Eremin O. Reversal of Hartmann’s colostomy. J R Coll Surg Edinb. 1994;39:239-42.