What is Hartmann's Procedure?

Hartmann's procedure is an emergency operation that removes the diseased segment of the sigmoid colon or rectum, closes the rectal stump, and creates a temporary end colostomy in the left lower abdomen. It is performed when primary anastomosis (bowel joining) is unsafe — due to peritoneal contamination, poor bowel preparation, haemodynamic instability, or malnutrition.

When is Hartmann's Procedure Performed?

• Perforated diverticulitis with faecal peritonitis (Hinchey III/IV)
• Obstructed left colon or rectal cancer with bowel perforation
• Traumatic colon injury with contamination
• Anastomotic breakdown after previous colorectal surgery
• Ischaemic colitis with perforation

Hartmann's Reversal

Once the patient has recovered (usually 3–6 months after the initial surgery), the colostomy can be reversed — the colon is re-joined to the rectal stump. Reversal is a major operation in its own right and carries significant complication risks. Approximately 30–50% of patients who have Hartmann's procedure ultimately never have the reversal, due to age, comorbidity, or patient preference.