Obstructive Resection for Certain Acute Conditions of the Colon

About 1900, Mikulicz modified the procedures of Block and Paul championing the exteriorization operation for colon surgery. With this technique a loop of colon, usually the sigmoid, was exteriorized through a stab wound. After several days the exteriorized colon containing the lesion was removed by knife or cautery. One week later a crushing clamp was applied to the spur and left in place until the tissue necrosed. Subsequently, 14% of the fecal fistulas would close spontaneously, the remainder requiring operative closure. This new principle in colonic surgery became firmly established as being highly desirable because it reduced the mortality of colon surgery from 40% to 50% to approximately 15%.

Subsequent improved modifications of the Mikulicz procedure were developed by Rankin⁷ and Lahey.⁵ Both of these modifications differ from the original in that the exteriorized bowel is removed at the time of the original surgical procedure. The Rankin procedure