Transverse Blowhole Colostomy versus Hartmann’s for Urgent Management of Large Bowel Obstruction Secondary to Diverticular Stricture

Abstract Purpose A sigmoid resection with end colostomy (Hartmann’s procedure) is the procedure of choice when a large bowel obstruction secondary to diverticular disease requires surgery. Less morbid alternatives are less common. This study compares a transverse blowhole colostomy as a first-stage intervention in diverticular-associated obstruction. Our primary aim was to compare colostomy reversal rates and postoperative outcomes between blowhole colostomy and Hartmann’s procedure. Methods This is a single-center, retrospective cohort study. An institutional database was utilized to retrospectively identify adult patients who underwent Hartmann’s procedure or blowhole colostomy for diverticular strictures with obstruction between 2012 and 2023. Results Thirty-nine patients underwent Hartmann’s procedure for diverticular strictures with obstruction and fifteen patients underwent blowhole colostomy. The blowhole colostomy group had a significantly shorter postoperative length of stay (median 5 vs. 8 days, p  = 0.01). Colostomy reversal was more frequent in the blowhole group (81.3% vs. 56.4%, p = 0.08), with a shorter median time to reversal (3 months vs. 4.7 months, p = 0.01). A significant increase in reversals performed using a minimally invasive approach (84.6% vs. 50%, p < 0.01) occurred in the blowhole colostomy group. No significant differences were observed in other postoperative outcomes, including proximal diversion after colostomy reversal. Conclusions Blowhole colostomy may be a viable alternative to a Hartmann’s procedure for diverticular-associated large bowel obstruction, offering potential benefits such as shorter hospital stays, higher rates of colostomy reversal, and a greater likelihood of minimally invasive reversal. Further prospective studies are needed to confirm these findings.