Restoration of intestinal continuity following Hartmann's procedure is associated with high morbidity (anastomotic leak rates 4-16 per cent) and mortality (0-4 per cent) rates. A total of 178 patients, under the care of seven different surgical units, underwent reversal of Hartmann's procedure during a 5-year period, representing the largest series yet reported. The mortality rate of the study group was 0.6 per cent, the anastomotic leak rate was 3.9 per cent and the incidence of anastomotic stricture was 6.7 per cent. The median time interval between resection and reversal was 92 days and no relation was found between timing and complications. Anastomotic stricture occurred significantly more commonly in stapled than in sutured anastomoses (P < 0.05); however, leaks were equally common in both types. The mean age of the patients who developed major complications was not statistically different from that of the rest of the study group and there was no difference in premorbid state. The authors believe that the low complication rates reported in this series may be attributable to the high level of operator experience in performing this technically difficult procedure, which was done by a consultant in 66 per cent of cases and by a senior registrar in 33 per cent.

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Primary necrotizing fasciitis of the breast is extremely rare. We describe a case of a 51-year-old diabetic smoker who presented with primary necrotizing fasciitis of the breast, with signs of severe systemic sepsis. She required intravenous antibiotics, radical emergency surgery, intensive care treatment and inotropic support. After daily wound inspections and changes of dressings, the wound was amenable to delayed primary closure on day 6. We describe this case in detail and review the literature on this extremely rare, but potentially fatal, infection.