Hartmann’s Procedure

Procedure Snapshot

• Indication: Obstructing or perforated sigmoid disease (diverticulitis or cancer).
• Expected duration: ___
• Special instruments: Linear stapler, retractor, stoma supplies.

Step Workflow

1. Midline incision; mobilize sigmoid colon.
2. Identify and divide inferior mesenteric vessels.
3. Transect rectum above peritoneal reflection.
4. Exteriorize proximal end as end colostomy.
5. Close distal rectal stump (Hartmann’s pouch).

Key Pimp Questions

• Q: Indication for Hartmann vs primary anastomosis?
  A: Gross contamination or instability.
• Q: Reversal success rate?
  A: ___ (PMID 27890105).

Critical Anatomy

• Landmarks: Sigmoid mesentery, ureter, inferior mesenteric artery.
• Danger zones: Left ureter, hypogastric nerves.

Informed Consent Highlights

• Risks: Leak __, bleeding __, stoma complications ___.

Post-op Considerations

• Ostomy care; reversal ≥ 3 months later if fit.

References

• Chassin’s, Colorectal section.
• Clinical Scenarios, Colon chapter.
• Vermeulen 2016 (PMID 27890105).