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文献考察：１）大腸閉塞例で67%に一期的手術が可能．
Tech Coloproctol. 2004 Nov;8 Suppl 1:s82-4.
Surgical management of large bowel obstruction due to colonic cancer.
Gatsoulis N, Roukounakis N, Kafetzis I, Mavrakis G.
BACKGROUND: Bowel obstruction represents a common surgical emergency. The purpose of this study is to highlight our principles while managing cases of large bowel obstruction (LBO) due to colonic carcinoma. METHODS: Twenty-one patients with LBO underwent emergency surgery. Patients with LBO caused by obstructive malignant colonic lesions underwent either with one-stage primary resection and anastomosis (14 patients, 67%) or two-stage operation (7 patients, 33%). RESULTS: There were no operation-related complications. The average length of hospitalisation was 14 days with a range from 10 to 23 days. Postoperative mortality was 14%. CONCLUSIONS: One-stage primary resection and anastomosis of the large bowel, is a feasible option in cases of emergency. LBO caused by colonic carcinoma can be performed with acceptable morbidity and mortality whenever comorbidity of the patient is not a contraindication.PMID: 15655653
文献考察：２）右側同様，左側でも一期的手術が可能．
Am J Surg. 2005 Apr;189(4):384-7.
Comparison of one-stage resection and anastomosis of acute complete obstruction of left and right colon.
Hsu TC.
BACKGROUND: Although acute obstruction of the right colon is usually handled by primary anastomosis following resection, many surgeons are reluctant to offer one-stage resection and anastomosis to patients with obstructive lesions of the left colon. The aim of the study is to compare the immediate result of one-stage resection and anastomosis for patients with acute complete obstruction of the right colon versus left colon. METHODS: From January 1986 to December 2003, 214 cases of acute colonic obstruction were managed with one-stage resection and anastomosis by a single surgeon. Eighty patients were operated on for obstructive lesions of the right colon, 71 of them for carcinoma of the colon. Operative mortality was 10% (8/80); all except 2 patients died of respiratory failure. There were 2 cases (2.5%) of anastomotic leakage. One hundred thirty-four patients were operated on for obstructive lesions of the left colon, 127 of them for carcinomas of the colon and rectum. Operative mortality was 1.5% (2/134); both patients died of metastasis from the colorectal cancer following surgery. There were 3 cases (2.3%) of anastomotic leakage. CONCLUSION: This experience suggests that an anastomosis can be performed as safely in patients with acute obstruction of the left colon as in those with acute obstruction of the right colon. Mortality following resection and anastomosis is actually lower in left than right colonic obstruction. Neither intraoperative irrigation nor routine subtotal colectomy was found to be necessary in patients with acute colonic obstruction. Intraoperative decompression should be considered in left and also right colonic obstruction prior to the anastomosis following colonic resection.PMID: 15820447
文献考察：３）結腸（脾彎曲部より左側）・直腸の救急手術例323例（閉塞例：37.5%，穿孔例：37.5%，経皮的ドレナージ不可能な膿瘍：25.1%）．Hartmann手術例より１期的切除・吻合例に合併症が少ない．腹腔内が膿や糞便で汚染されていても比較的安全に1期的切除・吻合が行える．
Colorectal Dis. 2003 May;5(3):262-9.
Safety of primary anastomosis in emergency colo-rectal surgery.
Zorcolo L, Covotta L, Carlomagno N, Bartolo DC.
BACKGROUND: The surgical management of left-sided large bowel emergency patients remains controversial. There has been an increasing trend towards primary reconstructive surgery. The main dilemma remains appropriate patient selection for primary anastomosis. METHODS: The records of 323 patients who presented as acute emergencies and underwent surgery between January 1990 and December 2000 for left-sided colorectal cancer and diverticular disease were reviewed, to compare the outcome of resection and primary anastomosis with Hartmann's procedure. Patients were stratified into 3 groups according to whether the presentation was with localized or generalized peritonitis, or with obstruction. RESULTS: Resection and anastomosis was carried out in 176 (55.7%) patients with a 30-day mortality of 5.7%. Anastomotic dehiscence occurred in 9 (5.1%) patients, with no difference between the three groups. Wound sepsis occurred in 8 (4.5%) patients, and the median hospital stay was 13 days. Hartmann's resection was associated with a higher incidence of systemic and surgical morbidity (39.5% and 24.3%, respectively). The mortality rates in those selected for primary anastomosis (5.7%) compared favourably with those undergoing Hartmann's resections (20.4%) (P
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