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INTRAOPERATORY DIFFICULTIES IN OCLUSSIVE COLON CANCER

Introduction.The most frequent complications of colon cancer are hemoragy and intestinal occlusion. Pacients with colon cancer are surgical emergencies, and elevate special problems related to operatory technik and the treatment of the oclusional shock. Method and material: An 88 pacients lot was studied, which were operated of occlusive colon tumor, in a 3 years period. Results: 43,1% of the cases were in II stage TNM, 40,9% in III stage, and 16% in IV stage. Tumors localization was: ascendant 20%, transverse 9%,descendent 16%, and sigmoid 55%. Surgical procedures that were used :39% Hartmann operation, 20% right hemicolectomy, 21% segmentary colectomy, 14% left hemicolectomy, palliative external derivations 6%. Intraoperatory difficulties were: satellite lymphnodes invasion in 37% of the cases, close peritumoral adherentions 23%, perforations with localized peritonitis 15%, hepatic metastases 13%, penetration in nearby organs 8%, fistulas 4%. Discutions: occlusive colon cancer involves more frequently the left colon, especially the sigmoid. There are intraoperatory difficulties related to releasing the tumor from the adherentions, related to the dissection of satellite tumoral adenopathy, and to the invasion of nearby organs , which implicate suplimentary rezections. The presence of single or small number of accessible hepatic metastases allows their excision in the same operatory time. A special problem is the inequality of supra and subtumoral segments, which increases the risk of the anastomotic dehiscence. Thats why, in this situations, every time possible, its wiser to do a Hartmann procedure with anus against nature. Conclusions: Oclusive colon cancer elevates important problems to the surgeon related to the loco-regional and distant invation of the neoplasia, on one side, and on the other, related to the tehnical solution of intestinal transit restoration. In the left colon localizations, in situation of great distention of postrezection restant proximal segment colon, Hatmann operation in indicated. Key words: occlusive colon cancer, Hartmann operation.