Those who require immediate surgery (in less than 24 hours) have

• proven or suspected gangrene

• severe peritonitis,

• life threatening infection or,

• total disruption of intestinal continuity

In these, apart from intestinal resection if required, the two intestinal ends are best brought out as diversion proximal stoma, and mucous distal stoma, (to be joined at a later date, as a second stage). Primary anastomosis in these circumstances invariably breaks down.

Early surgery (with 3-5 days) is required in those with

• distal obstruction

• specific disease

• colovesical fistula and

• an abscess or collection which cannot be adequately drained percutane-ously under US/CT guidance

Formerly loop transverse colostomy was the preferred diversion whenever it was feasible, but during the last 5-10 years (loop ileostomy which is nearly always possible, is the diversion of choice. Ileostomies offer an advantage because the stoma bag fits better, the odor is less, interferes less with subsequent colonic resection and anastomosis, and closure is easier with less morbidity.

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