[Surgical tactics in extensive necrosis of the sigmoid which had been brought downwards]

Since 1982 the authors perform early (on the 4th-10th day) reoperations in extensive necroses of the sigmoid colon which had been transposed downwards after abdomino-anal resection of the rectum. The reoperation consists in resection of the affected segment of the intestine (usually the whole remaining sigmoid colon) and downward retransposition of the descending or the left half of the transverse colon. Nine such operations were performed; in 8 patients the results were favorable, one 70-year-old female patient died. The first operations had been performed for carcinoma (5 patients), endometriosis (one patient), and anorectal developmental anomalies (3 adult females). It proved that it is advisable to undertake downward retransposition as an emergency manipulation immediately after diagnosing extensive necrosis of the downward transposed sigmoid colon, which usually happens on the 4th-6th day after the main operation. The intestinal wall is still not undergoing disintegration in this period and there is no purulent melting of the areolar tissue of the walls of the true pelvis, i.e., the danger of purulent complications developing after downward retransposition is relatively small, particularly if the cavity of the true pelvis is drained abundantly and lavaged regularly with antiseptic solutions in the postoperative period. Such reoperations are especially advisable in individuals under the age of 60, and usually ensure favorable immediate and late-term functional results.