Hartmann's procedure is an emergency resection (usually of the sigmoid) with creation of an end colostomy and closure of the rectal stump — without an immediate anastomosis, when that would be dangerous. Bowel continuity can be restored at a second stage.
What is the operation?
It is resection of the affected segment (usually sigmoid) with creation of an end colostomy and closure of the rectal stump — without an immediate anastomosis. It is a "damage-control" operation in an emergency, when an anastomosis would be dangerous.
Bowel continuity can be restored later (Hartmann's reversal).
When is it needed?
It is indicated in emergencies: complicated diverticulitis (perforation/peritonitis), obstructing or perforated cancer — when the inflamed/unstable field makes an immediate anastomosis high-risk for a leak.
Preparation
As an emergency, it is preceded by rapid stabilisation (fluids, antibiotics), imaging and, where time allows, stoma site marking.
How it's done
The affected segment is removed; the proximal colon is brought out as an end colostomy and the rectal stump is closed, deliberately avoiding a dangerous anastomosis. This choice prioritises the safety of a severely ill patient.
Resection & end colostomy
Removal of the affected segment and safe diversion, without a dangerous anastomosis.
Avoiding a leak
Chosen when an inflamed/unstable field makes an immediate anastomosis dangerous.
Hartmann's reversal
Restoring continuity and closing the stoma after full recovery.
Recovery
Recovery depends on the severity of the acute disease; colostomy management education follows. The reversal is planned later, as a separate operation, once the patient has fully recovered.
Risks & outcomes
Complications relate to infection, the wound and the stoma. The stoma is usually temporary, but in some patients remains permanent depending on the situation. The operation avoids the leak risk of an emergency anastomosis.
Frequently asked questions
Is the colostomy permanent?
Not necessarily. The stoma is usually temporary and can be reversed at a second stage, once the patient has recovered. In some cases it remains permanent, depending on the situation.
Why not an immediate anastomosis?
In an inflamed or unstable field (e.g. peritonitis), an immediate anastomosis has a high leak risk. Hartmann's procedure avoids that risk.
When is the reversal done?
It is planned after full recovery, usually after some months, as a separate operation.
Is it a major operation?
It is performed in an emergency, often severe setting; the goal is safe management of the acute disease with the lowest possible risk.