Primary anastomosis after intestinal resection for abdominal sepsis: case report and review of the literatura
DOI:
https://doi.org/10.70577/v54gdc02Keywords:
primary anastomosis; Hartmann's procedure; abdominal sepsis; intestinal necrosis; case reportAbstract
Introduction: The decision between primary anastomosis and Hartmann's procedure in patients with abdominal sepsis and intestinal necrosis remains a subject of debate. Contemporary evidence suggests that, in carefully selected patients, primary anastomosis offers advantages in terms of quality of life without compromising surgical safety. Objective: To describe the short-term evolution of a young patient without significant comorbidities who underwent intestinal resection and primary anastomosis in the context of abdominal sepsis. Methods: Case report. Results: A 23-year-old female patient, without significant clinical or surgical history, who after an appendectomy returned to the emergency department with abdominal pain, fever, and clinical findings of pelvic inflammatory disease. Free fluid in the abdominal cavity and marked leukocytosis with neutrophilia were identified. It was classified as abdominal sepsis and, given the refusal of reception at a higher-complexity hospital and the appearance of signs of hemodynamic instability, emergency surgical intervention was decided. Intraoperatively, necrosis of a significant segment of the ileum, purulent fluid in the abdominal cavity, metabolic acidosis, and early-stage septic shock were identified. Intestinal resection and primary side-to-side anastomosis in two layers were performed, without a protective stoma. Postoperative evolution was favorable during hospitalization and at two- and three-month follow-up. Conclusions: This case supports current evidence favoring primary anastomosis in young patients with adequate nutritional status and early-stage systemic failure, even in the presence of abdominal sepsis. The surgical decision must be individualized considering the clinical condition, intraoperative findings, and the experience of the treating team.
Downloads
References
Agirman, E., Disci, E., Peksoz, R., & Atamanalp, S. S. (2024). Primary anastomosis versus stoma following urgent sigmoidectomy for sigmoid volvulus: 58-year experience in a tertiary referral center. Pakistan journal of medical sciences, 40(11), 2513. DOI: https://doi.org/10.12669/pjms.40.11.10543
AlSulaim, H. A., Garfinkle, R., Marinescu, D., Morin, N., Ghitulescu, G. A., Vasilevsky, C. A., ... & Boutros, M. (2023). Is the Hartmann’s procedure for diverticulitis obsolete? National trends in colectomy for diverticulitis in the emergency setting from 1993 to 2018. Surgical Endoscopy, 37(10), 7717-7728. DOI: https://doi.org/10.1007/s00464-023-10317-1
Aras, A. (2025). Primary anastomosis versus Hartmann’s procedure in obstructing colorectal cancer: a retrospective cohort study. Current Oncology, 32(11), 636. DOI: https://doi.org/10.3390/curroncol32110636
Awedew, A. F., Asefa, Z., & Enkoye, B. D. (2023). Comparing resection and primary anastomosis versus Hartmann’s stoma on the mortality and morbidity of gangrenous sigmoid volvulus: Systematic review and meta-analysis. Ethiopian journal of health sciences, 33(6). DOI: https://doi.org/10.4314/ejhs.v33i6.19
Cairns, C. A., Carlisle, K. M., Ryan, K. A., Chen, C., Ghneim, M. H., & Falvey, J. (2023). Exploring differences in days alive and at home after hartmann’s procedure vs primary anastomosis with proximal diversion for older adults with diverticulitis. Journal of the American College of Surgeons, 10-1097.
Ceresoli, M., Podda, M., Ferro, C. A. P., Cioffi, S. P. B., Biloslavo, A., Cozza, V., & Coccolini, F. (2026). Emergency left side colectomy and primary anastomosis with or without diverting stoma: a comparative study. International Journal of Colorectal Disease. DOI: https://doi.org/10.1007/s00384-026-05177-9
Ceylan, C., Kocaaslan, H., Baran, N. T., Saglam, K., Angin, Y. S., & Aydin, C. (2024). Outcomes of resection anastomosis versus Hartmann's procedure in sigmoid volvulus. Ankara Eğitim ve Araştırma Hastanesi Dergisi, 57(1), 33-37. https://doi.org/10.20492/aeahtd.1281940 DOI: https://doi.org/10.20492/aeahtd.1281940
Dreifuss, N. H., Casas, M. A., Angeramo, C. A., Schlottmann, F., Laxague, F., Bun, M. E., & Rotholtz, N. A. (2023). Sigmoid resection and primary anastomosis for perforated diverticulitis with peritonitis: To divert or not to divert. A systematic review and meta-analysis. Surgery, 174(6), 180-188. https://doi.org/10.1016/j.surg.2023.04.035 DOI: https://doi.org/10.1016/j.surg.2023.04.035
Edomskis, P. P., Hoek, V. T., Stark, P. W., Lambrichts, D. P. V., Draaisma, W. A., Consten, E. C. J., Bemelman, W. A., & Lange, J. F. (2022). Hartmann's procedure versus sigmoidectomy with primary anastomosis for perforated diverticulitis with purulent or fecal peritonitis: Three-year follow-up of a randomized controlled trial. International Journal of Surgery, 98. https://doi.org/10.1016/j.ijsu.2021.106221 DOI: https://doi.org/10.1016/j.ijsu.2021.106221
Fa, A., & Hawkins, A. T. (2024). Surgeon perspective on the surgical treatment of acute diverticulitis: Hartmann’s Procedure vs Primary Anastomosis.
Hartmann, H. (1921). Nouveau procédé d'ablation des cancers de la partie terminale du colon pelvien. Trentième Congrès de Chirurgie Strasbourg. http://www.grandroundsjournal.com/articles/gr089001/hartmann-original.pdf
Lambrichts, D. P., Vennix, S., Musters, G. D., Mulder, I. M., Swank, H. A., Hoofwijk, A. G., ... & Heisterkamp, J. (2019). Hartmann's procedure versus sigmoidectomy with primary anastomosis for perforated diverticulitis with purulent or faecal peritonitis (LADIES): a multicentre, parallel-group, randomised, open-label, superiority trial. The Lancet Gastroenterology & Hepatology, 4(8), 599-610. DOI: https://doi.org/10.1016/S2468-1253(19)30174-8
Lee, Y., McKechnie, T., Samarasinghe, Y., Eskicioglu, C., Kuhnen, A. H., & Hong, D. (2023). Primary anastomosis with diverting loop ileostomy versus Hartmann's procedure for acute complicated diverticulitis: Analysis of the National Inpatient Sample 2015-2019. International Journal of Colorectal Disease, 38(156). https://doi.org/10.1007/s00384-023-04452-3 DOI: https://doi.org/10.1007/s00384-023-04452-3
Merabishvili, G., Mosidze, B., Demetrashvili, Z., & Agdogmelashvili, I. (2022). Comparison of Hartmann's procedure versus resection with primary anastomosis in management of left-sided colon cancer obstruction. Georgian Medical News, 3(324), 21-25.
Mugisha, A. I. (2026). Hartmann's procedure versus primary anastomosis: Patient-centered outcomes in older adults. Annals of Medicine and Surgery, 88(6), 3795-3796. https://doi.org/10.1097/MS9.0000000000005004 DOI: https://doi.org/10.1097/MS9.0000000000005004
Mwizerwa, J. L., Cyuzuzo, T., Gasakure, M., Nitrenganya, F., & Rickard, J. (2025). Sigmoid resection with primary anastomosis versus Hartmann's procedure for sigmoid volvulus: A systematic review and meta-analysis. East and Central African Journal of Surgery, 30(3), 22-33. https://doi.org/10.4314/ecajs.v30i3.4 DOI: https://doi.org/10.4314/ecajs.v30i3.4
Omoto, R. (2024). Comparison between primary anastomosis without diverting stoma and Hartmann's procedure for colorectal perforation: A retrospective observational study. Cureus, 16(4), e58402. https://doi.org/10.7759/cureus.58402 DOI: https://doi.org/10.7759/cureus.58402
Pellegrin, A., Alves, A., Beyer-Berjot, L., Zerbib, P., Bridoux, V., Manceau, G., Panis, Y., Buscail, E., Venara, A., Khaoudy, I., Gaillard, M., Ortega-Deballon, P., Thobie, A., Menahem, B., Eveno, C., Bonnel, C., Mabrut, J. Y., Badic, B., Godet, C., ... Sabbagh, C. (2025). Hartmann's procedure versus primary anastomosis for Hinchey III or IV sigmoid diverticulitis: A propensity score analysis of a retrospective national cohort study. Surgical Endoscopy, 39, 5676-5688. https://doi.org/10.1007/s00464-025-11906-y DOI: https://doi.org/10.1007/s00464-025-11906-y
Pinson, J., Tuech, J. J., Ouaissi, M., Mathonnet, M., Mauvais, F., Houivet, E., Lacroix, E., Rondeaux, J., Sabbagh, C., & Bridoux, V. (2022). Role of protective stoma after primary anastomosis for generalized peritonitis due to perforated diverticulitis (DIVERTI-2): Rationale and design (NCT04604730). BMC Surgery, 22(191), 128. https://doi.org/10.1186/s12893-022-01589-w DOI: https://doi.org/10.1186/s12893-022-01589-w
Ríos Díaz, A. J., Bevilacqua, L. A., Habarth-Morales, T. E., Zalewski, A., Metcalfe, D., Costanzo, C., Yeo, C. J., & Palazzo, F. (2024). Primary anastomosis with diverting loop ileostomy versus Hartmann's procedure for acute diverticulitis: What happens after discharge? Results of a nationwide analysis. Surgical Endoscopy, 38, 2777-2787. https://doi.org/10.1007/s00464-024-10752-8 DOI: https://doi.org/10.1007/s00464-024-10752-8
Shahmoradi, M. K., Farahani, P. K., & Sharifian, M. (2021). Evaluating outcomes of primary anastomosis versus Hartmann's procedure in sigmoid volvulus: A retrospective cohort study. Annals of Medicine and Surgery, 62, 160-163. https://doi.org/10.1016/j.amsu.2021.01.019 DOI: https://doi.org/10.1016/j.amsu.2021.01.019
Toro, A., Mannino, M., Reale, G., Cappello, G., & Di Carlo, I. (2012). Primary anastomosis vs Hartmann procedure in acute complicated diverticulitis: Evolution over the last twenty years. Chirurgia, 107(5), 598-604.
Vergara-Fernández, O., Morales-Cruz, M., Armillas-Canseco, F., Pérez-Soto, R., Arcia-Guerra, E., & Trejo-Ávila, M. (2022). Hartmann's procedure versus primary anastomosis for Hinchey stage III diverticulitis: A prospective case-control study. Revista de Gastroenterología de México, 87(4), 509-512. https://doi.org/10.1016/j.rgmxen.2022.09.001 DOI: https://doi.org/10.1016/j.rgmxen.2022.09.001
Wang, Z., Sheng, W., Dai, S., Li, X., Lin, G., & Kang, X. (2025). The safety of primary anastomosis without protective stoma in emergency left colon surgery: A meta-analysis. Journal of Investigative Surgery. https://doi.org/10.1080/08941939.2025.2520992 DOI: https://doi.org/10.1080/08941939.2025.2520992
Yalkın, O., Altintoprak, F., Uzunoğlu, M. Y., Yildiz, Y. A., Kamburoğlu, M. B., Firat, N., & Çelebi, F. (2022). Factors predicting the reversal of Hartmann's procedure. BioMed Research International, 2022(1). https://doi.org/10.1155/2022/7831498 DOI: https://doi.org/10.1155/2022/7831498
Yu, M. Z., Fang, C. Y., Huang, W. L., Yang, H. Y., & Chu, C. T. (2024). A comparison between Hartmann's procedure, primary anastomosis, and primary anastomosis with defunctioning stoma in Hinchey III and IV diverticulitis. Journal of Society of Colon and Rectal Surgeons, Taiwan, 35, 201-209. https://doi.org/10.6312/SCRSTW.202412_35(4).11241
Downloads
Published
Issue
Section
License
Copyright (c) 2026 Esther Salomé Loyola Cevallos, Jaime Lenín Veintimilla Hurtado, Heriberto Ortiz Martín, Esteban Germán Lojano Munzón, Leslie Suley Rodríguez Campoverde (Autor/a)
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
