Intestinal obstruction after excision of the rectum

Over a 5-year period, 33 patients underwent excision of the rectum in the same unit of Aberdeen Royal Infirmary. Six patients in whom the abdominal contents were allowed to fall into the denuded pelvis showed a uniform pattern of delayed intestinal transit. Two of the patients required reoperation and one died. A similar pattern was not seen in patients managed by other methods. Even if leaving the pelvic peritoneum open were to improve the likelihood of primary perineal healing, for which there is no good evidence, the risks are such that the practice must be regarded as unacceptable unless omentum is mobilized to occupy the pelvic cavity.