Aira Hospital

Hartmann’s procedure is the name used for a procedure where the distal part of the sigmoid/rectum is closed and the proximal part is exteriorized as a colostomy. It is most commonly used after resection of the sigmoid due to a volvolus with gangrene or due to a distal malignancy of the colon when anastomosis is not advisable or not possible for technical reasons.

The following procedure was performed due to a sigmoid volvolus with gangrene

 

The distended bowel is deflated with a needle to avoid unintentional rupture of the friable bowel wall.

 

The deflated loop is untwisted

 

The gangrenous part of the bowel is isolated between clamps

 

The peritoneal layer of the mesosigmoideum cut with scissors. The vessels are isolated by finger dissection, clamped, cut and ligated.

 

The gangrenous bowel is cut and removed

 

The rectal stump is closed with a double layer of continuous suture. The suture ends are left long to facilitate identification of the stump at the second procedure when reestablishing the continuity of the intestine.

 

The skin at the intended place for the colostomy is grasped and lifted up. A straight cut with the knife results in a round opening. A cross formed incision in the fascia with manually dilatation of the muscles makes the colostomy opening.

 

The proximal sigmoid is brought out through the colostomy opening and the abdominal incision is closed

 

The colostomy is completed

 

 In appropriate cases where the colostomy is not intended to be permanent, the continuity of the colon can be reestablished with closure of the colostomy and anastomosis after some weeks.