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|Hartmann's procedure
💡 Hartmann’s Procedure is named after the French surgeon Henri Hartmann. It is commonly performed for severe diverticulitis, bowel cancer, or trauma. The operation involves removing a diseased section of bowel and creating a colostomy (stoma), while sealing off the rectal stump.
📘 About
- Named after Henri Hartmann.
- Removes diseased/damaged lower colon.
- Creates a colostomy (stoma) ➡️ bowel contents leave via the abdomen.
- The rectal stump is sealed off internally.
- May be temporary or permanent depending on disease and recovery.
🖼️ Diagram
🎯 Indications
- ⚡ Diverticulitis – complicated (perforation, abscess, fistula).
- 🎗️ Colon cancer requiring safe resection.
- 🩸 Trauma to the colon.
- 🦠 Infection (e.g. ischaemic colitis).
- 🚫 Obstruction not relieved by other means.
🔪 Procedure Steps
- 💤 General anaesthesia.
- 📏 Abdominal incision to access bowel.
- ✂️ Diseased bowel segment resected.
- 🔄 Colostomy formed (bowel brought to skin).
- 🚫 Rectal stump sealed off.
🧑⚕️ Preoperative Preparation
- 👩⚕️ Stoma nurse consultation: education and site marking.
- 🧪 Investigations: bloods, imaging, physical exam.
- 🚽 Bowel prep: laxatives/enemas unless emergency.
- 💊 Medication review: adjust anticoagulants/antiplatelets.
🏥 Postoperative Care
- 📊 Monitor vitals, stoma output, and infection signs.
- 🩹 Stoma care: education and support.
- 🥣 Diet: liquids → low fibre → solids as tolerated.
- 💊 Pain management, avoid NSAIDs if bowel-sensitive.
- 💧 Hydration to maintain balance with stoma losses.
⚠️ Potential Complications
- 🔴 Stoma issues: prolapse, retraction, infection.
- 🦠 Wound/abdominal infection.
- 💧 Anastomotic leak (if an anastomosis created).
- 💪 Hernia at stoma site.
- 🪢 Adhesions → risk of future obstruction.
📚 References