Finding predictive factors that may affect rectal stump blowout after Hartmann's procedure. Why are rectal tubes still in routine practice?

BACKGROUND: Among the complications associated with Hartmann's procedure, rectal stump blowout appears to be underrecognised. Despite the widespread practice of leaving a catheter in the rectal remnant, there is limited scientific evidence supporting this approach. Other risk factors have been infrequently and inconsistently reported. We analysed our five-year experience to identify predictors of stump blowout following Hartmann's, and to determine whether the use of rectal tubes is of any clinical benefit. METHODS: This retrospective study included all patients who underwent emergency Hartmann's procedure between 2020 and 2025. Primary and secondary outcomes were rectal stump blowout and its latency in days from the surgery. Univariate analysis was conducted to identify variables of interest, which were subsequently entered into a regression model. RESULTS: Among 133 patients included in the study, 9 (6.8%) experienced rectal stump blowout. Black ethnicity (P=0.07; odds ratio 7.4), diagnoses involving colonic perforation (P=0.08; odds ratio 5.6), and placement of pelvic drain (P=0.054; relative risk 0.91) demonstrated nearly significant association with blowout but did not add significantly to the model. Patients with Charlson Comorbidity Index ≥ 7 (P=0.02) and those who underwent multiple bowel resections during Hartmann's procedure (P=0.005) were 9.2-fold and 28.5-fold more likely, respectively, to develop stump leak. The use of rectal tubes did not influence the incidence of blowout (P=0.49). CONCLUSIONS: Highly comorbid patients and those requiring additional bowel resections are at increased risk of post-Hartmann's stump leak. Routine use of protective rectal tubes does not alter the probability to develop a rectal stump blowout.