Outcomes of Emergency Resection and Primary Anastomosis of the Large Bowel in Unprepared Bowel during Acute Large Bowel Obstruction

Background: Acute large intestinal obstruction is a frequent surgical emergency with high morbidity and mortality. One-stage primary resection and anastomosis without intraoperative colonic lavage in unprepared bowel is a promising surgical option that avoids multistage procedures and colostomy. This study evaluates the clinical outcomes of this approach.
Aim: To evaluate that emergency resection and primary anastomosis in acute large intestinal obstruction in unprepared bowel appears to be a safe and effective procedure in selected patients.
Methods: This prospective study included 150 patients presenting with acute large bowel obstruction at Dinajpur Medical College Hospital from July 2022 to July 2024. Patients with generalized peritonitis or bowel perforation were excluded. Emergency resection and primary end-to-end anastomosis were performed using single-layer interrupted sutures without colonic lavage. Postoperative morbidity, mortality, and hospital stay were recorded.
Results: Of the 150 patients (88% male, mean age 55 years), sigmoid volvulus was the predominant cause (94%). Gangrenous bowel was present in 32%. Postoperative complications included wound infection in 14%, wound dehiscence in 4%, anastomotic leak in 2%, and mortality in 2%. Mean hospital stay was 12.5 days. Morbidity was higher in patients with gangrenous bowel.
Conclusion: Emergency resection and primary anastomosis without colonic lavage in selected patients with acute large bowel obstruction is a safe, effective procedure with acceptable morbidity and mortality, circumventing the need for staged surgery or colostomy.