Transverse Blowhole Colostomy Versus Hartmann's for Urgent Management of Large Bowel Obstruction Secondary to Diverticular Stricture.

Document Type

Article

Publication Date

1-8-2026

Publication Title

International Journal of Colorectal Disease

Abstract

PURPOSE: Sigmoid resection with end colostomy (Hartmann's procedure) is the procedure of choice when a large bowel obstruction secondary to diverticular disease requires surgery. Less morbid alternatives are less common. This study compares a transverse blowhole colostomy as a first-stage intervention in diverticular-associated obstruction. Our primary aim was to compare colostomy reversal rates and postoperative outcomes between blowhole colostomy and Hartmann's procedure.

METHODS: This is a single-center, retrospective cohort study. An institutional database was utilized to retrospectively identify adult patients who underwent Hartmann's procedure or blowhole colostomy for diverticular strictures with obstruction between 2012 and 2023.

RESULTS: Thirty-nine patients underwent Hartmann's procedure for diverticular strictures with obstruction and 15 patients underwent blowhole colostomy. The blowhole colostomy group had a significantly shorter postoperative length of stay (median 5 vs. 8 days, p = 0.01). Colostomy reversal was more frequent in the blowhole group (81.3% vs. 56.4%, p = 0.08), with a shorter median time to reversal (3 months vs. 4.7 months, p = 0.01). A significant increase in reversals performed using a minimally invasive approach (84.6% vs. 50%, p <  0.01) occurred in the blowhole colostomy group. No significant differences were observed in other postoperative outcomes, including proximal diversion after colostomy reversal.

CONCLUSIONS: Blowhole colostomy may be a viable alternative to a Hartmann's procedure for diverticular-associated large bowel obstruction, offering potential benefits such as shorter hospital stays, higher rates of colostomy reversal, and a greater likelihood of minimally invasive reversal. Further prospective studies are needed to confirm these findings.

Volume

41

Issue

1

First Page

18

Last Page

18

DOI

10.1007/s00384-025-05049-8

ISSN

1432-1262

PubMed ID

41504949

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