**Question:** A 60 years old man suffering from left colon Ca presented with acute Lt. colonic obstruction the treatment is -

a) Primary resection and Hartman's procedure
b) Defunctioning colostomy
c) Rt. hemicolectomy
d) Resection of whole Lt. bowel and end to end anastomosis
e) Conservative treatment

**Answer Explanation:**

**Core Concept:** Acute colonic obstruction is a life-threatening medical emergency that requires prompt and appropriate management. The treatment depends on the underlying cause, the severity, and the patient's condition. In this scenario, the patient is suffering from left colon cancer and presents with acute left colonic obstruction.

**Why the Correct Answer is Right:**

In this case, the correct treatment is:

d) Resection of whole Lt. bowel and end to end anastomosis

The underlying pathology is left colon cancer causing acute obstruction. This necessitates surgical intervention to relieve the obstruction and prevent life-threatening complications. Resection of the diseased bowel segment and anastomosis is the standard surgical approach for this scenario.

**Why Each Wrong Option is Incorrect:**

a) Primary resection and Hartman's procedure (Hartman's procedure involves colectomy, which involves removing the entire colon, and is not suitable for a partial obstruction caused by left colon cancer. This would result in a permanent colostomy and may not relieve the obstruction.)

b) Defunctioning colostomy (Colostomy is indicated in cases of severe ischemic colitis or severe obstruction where primary anastomosis is not possible. In this scenario, a primary anastomosis is feasible, so a colostomy is not required.)

c) Right hemicolectomy (Right hemicolectomy is performed for right colon cancer and not for left colon cancer causing acute obstruction.)

e) Conservative treatment (Conservative treatment is indicated in stable patients with mild to moderate obstruction where the underlying cause is reversible. In this case, the patient is acutely ill and requires surgical intervention.)

**Clinical Pearl:**

In cases of acute left colon cancer obstruction, prompt surgical intervention is crucial to prevent complications and improve patient outcomes. Primary anastomosis is a standard surgical approach for left colon cancer causing acute obstruction. A Hartman's procedure or right hemicolectomy are not suitable options. Conservative treatment is not appropriate unless the patient's condition is stable and reversible.