A patient whose colon has perforated and has faecal peritonitis presents as an emergency that will require urgent surgical intervention. The patient will first need to be resuscitated before theatre with intravenous fluids and broad-spectrum antibiotic cover. In an elderly patient resuscitation may involve other medical specialities.

The perforation means that there is a clear passage of faecal matter into the abdominal cavity, causing peritonitis. The mortality rate can be as high as 35% (Sher et al., 1999). The operation again can be a one- or two-stage operation, with a Hartmann's procedure (Keighley and Williams, 1997). There is evidence that a single-staged primary anastomosis can achieve good results without the need for Hartmann's procedure and colostomy (Zorcolo et al., 2003).

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