Advanced rectal cancer in a long-term Hartmann's pouch: a forgotten organ revisited

Abstract

SUMMARYHartmann's procedure is widely performed as a firststage operation in cases of left colon emergencies when a one stage management is judged to be unsafe. Forty per cent of patients with Hartmann's procedure never get their stoma reversed, ending with a permanent stoma. The distal excluded Hartmann's pouch is usually forgotten compared to the proximal functioning colon. A 70-year-old man with Hartmann's procedure carried out previously for complicated diverticular disease presented with bleeding per rectum. Invasive adenocarcinoma was confirmed on histology. Subsequent staging revealed a locally advanced rectal cancer. The tumour progressed despite a course of neoadjuvant chemoradiation. The general condition of the patient deteriorated with development of renal failure. The patient died a few weeks later. By reporting this case, we are revisiting the long forgotten Hartmann's pouch to highlight the potential pathologies in the distal stump and to emphasise that a distal stump should not be forgotten even in asymptomatic patients. BACKGROUND

Anal Atresia in a Patient Who Had Undergone Hartmann Procedure

“…It has been postulated that such chronic inflammation might increase the risk of malignancy. Hence, some authors have advocated periodic endoscopic evaluation of the Hartmann’s pouch even in asymptomatic patients [ 3 , 6 – 8 ]. However, there have been no reports of anal atresia following Hartmann procedure.…”