Successful emergency Hartmann procedure for perforated sigmoid colon cancer requiring splenic flexure mobilization under combined spinal-epidural anesthesia: a case report.

Objective

We report a case of an emergency Hartmann procedure with splenic flexure mobilization performed under combined spinal-epidural anesthesia (CSEA) in a patient with severe chronic obstructive pulmonary disease (COPD). Patient and

Methods

An 88-year-old man with severe COPD requiring home oxygen therapy presented with abdominal pain, constipation, and vomiting. Computed tomography revealed an obstructing sigmoid colon tumor with a mesocolic abscess, suspected proximal perforation, diffuse ascites, and synchronous hepatic metastases. Previous spirometric assessments demonstrated the following findings: vital capacity (VC), 2.77 L; %VC, 91.4%; forced expiratory volume in 1 second (FEV1), 0.75 L; %predicted FEV1, 33.5%; and FEV1/forced vital capacity (FVC), 35.2%. CSEA was selected because general anesthesia posed a high risk of postoperative pulmonary complications.

Results

Hartmann procedure with splenic flexure mobilization was successfully completed under CSEA. The operative time was 144 min, and blood loss was 92 mL. Mild shoulder pain occurred during upper-abdominal manipulation; however, conversion to general anesthesia was not required. No postoperative respiratory complications occurred and the patient was discharged on postoperative day 31. The patient died 15 months after surgery because of the progression of colon cancer.

Conclusion

CSEA may be a feasible alternative for carefully selected high-risk patients undergoing emergency colorectal surgery, even when splenic flexure mobilization is required.