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Ann Coloproctol > Accepted Articles
DOI: https://doi.org/10.3393/ac.2019.11.14    [Accepted]
Published online January 31, 2020.
Risk factors and management for left colonic perforation
Yilseok Joo  , Yujin Lee, Taeyoung Yoo, Jungbin Kim, Inseok Park, Geumhee Gwak, Hyunjin Cho, Keunho Yang, Kiwhan Kim, Byung-Noe Bae 
Department of surgery, Inje University Sanggye Paik Hospital, Seoul, Republic of Korea
Correspondence:  Byung-Noe Bae, Tel: 02-950-1017, Fax: 02-933-9389, 
Email: bnbae@paik.ac.kr
Received: 2 September 2019   • Revised: 7 November 2019   • Accepted: 14 November 2019
Abstract
Purposes: To identify factors significantly associated with mortality of patients with left colonic perforation, and to compare the outcome of the Hartmann procedure (HP) and primary repair (PR) or primary anastomosis (PA) in left colonic perforation patients without factors associated with mortality.
Methods
This retrospective study included patients who underwent surgery for left colonic perforation from January 2009 to February 2018. Preoperative factors related to postoperative mortality, including vital signs, laboratory findings, and intraoperative findings, were analyzed by type of operation. The chi-square, Fisher exact, and Mann-Whitney U tests were used to analyze the data.
Results
Ninety-one patients were included (36 men, 55 women), and 15 (16.5%) died postoperatively. Risk factors were age, leukopenia, thrombocytopenia, bleeding tendency, acute renal failure, hemodynamic instability, and existence of generalized peritonitis and feculent ascites. Advanced age, leukopenia, and acute renal failure were independent risk factors for mortality. Seventy-nine patients did not have leukopenia, and among them, 30 patients who underwent PR without diversion were excluded from the sub-analysis. HP was performed in 30 patients, and PR with diversion and PA with or without diversion were performed in 19. Compared to the other operative methods, HP had no benefit for reducing overall mortality (p=0.458) and morbidity.
Conclusions
Leukopenia could be an objective prognostic factor for left colonic perforation. Although HP is the gold standard for septic left colonic perforation, it did not improve overall mortality of the patients without leukopenia. For such patients, PR or PA could be a good option for left colonic perforation.
Key Words: Hartmann procedure; Colon perforation; Postoperative mortality


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