In Emergency department, 70 years old male presents with acute obstruction. He has Ca. descending colon, M/n of choice :
## **Core Concept**
The patient presents with acute obstruction due to carcinoma (Ca) of the descending colon. The management of choice in such a scenario involves relieving the obstruction and stabilizing the patient.
## **Why the Correct Answer is Right**
The correct answer involves **Hartmann's procedure**. This is a surgical operation that involves resection of the part of the colon with the tumor (in this case, the descending colon), closure of the rectal stump, and creation of a colostomy. Hartmann's procedure is often chosen in emergency situations like acute obstruction or perforation due to its rapidity and lower risk compared to primary anastomosis. This approach allows for immediate relief of the obstruction and can be reversed later if necessary.
## **Why Each Wrong Option is Incorrect**
- **Option A:** This option is incorrect because primary resection with anastomosis (without a stoma) carries a higher risk of anastomotic leakage in the setting of acute obstruction and is generally not recommended as the initial management in emergency situations.
- **Option B:** This option might suggest a less invasive approach but does not directly address the immediate need to relieve the obstruction and manage the tumor in an emergency setting.
- **Option C:** While stenting could be considered for palliation or as a bridge to surgery in some cases of obstruction, it may not be suitable or sufficient for a patient with an acute presentation and possible impending perforation or significant ischemia.
## **Clinical Pearl / High-Yield Fact**
A key point to remember is that Hartmann's procedure is a lifesaving operation in emergency situations involving the left-sided colon (like descending colon cancer) with complications such as obstruction or perforation. It allows for the immediate removal of the source of the problem while minimizing the risk of a more extensive surgery.
## **Correct Answer Line**
**Correct Answer: D. Hartmann's procedure.**