**Figure 1.**

*Surgical approach of the colon.*

ligation at the origin of the ileocolic vessels, right colic, and of the right branch of the middle colic vessels, followed by an ileo-colic end to end anastomosis (**Figure 2**).

If the obstructive tumor is located at the middle of the transverse colon, then you can opt for a transversectomy with omentectomy and resection of the mesocolon (**Figure 3**), and high ligation at the origin of the middle colic vessels. If the local anatomy is favorable, namely after an adequate mobilization of both the hepatic and the splenic flexure if we can obtain a resection margin of about 10 cm, then we can opt for a tension-free anastomosis. If the local anatomy is not favorable, it is recommended to perform an extended right hemicolectomy with omentectomy and high ligation of the vascular pedicles followed by an ileocolic anastomosis. This type of anastomosis is classified with the lowest fistula rate [24, 30–32].

If the occlusive tumor is located at the left third of the transverse colon, then an extended right hemicolectomy is recommended as long as we obtain an adequate distance resection margin as well as an adequate radial resection margin – all by maintaining the integrity of the visceral peritoneum sheets.

Location of the tumor at the level of the splenic flexure may be followed by segmental resection of the splenic angle, left omentectomy, resection of the mesocolon *Emergency Treatment of Transverse Colon Cancer DOI: http://dx.doi.org/10.5772/intechopen.99560*

**Figure 2.** *D2/3 extended right hemicolectomy.*

**Figure 3.** *D2/3 transverse colectomy.*

and ascending branches of the left colic vessels, extended gastrocolic lymphadenectomy and colo colic anastomosis TT, or extended right hemicolectomy with omentectomy, mesocolon excision and extended gastro-colic lymphadenectomy, prepancreatic lymphadenectomy followed by an ileocolic end to end anastomosis (**Figure 4**) [28, 29].

The principle of diversion or the protection of an anastomosis using an ileostomy [28] has lost ground lately, being today only an exceptional indication [33].

In certain particular situations, like in an emergency, it is useful to practice a subtotal colectomy (**Figure 5**), as radical as possible with ileo sigmoid anastomosis.

**Figure 4.** *D2/3 extended left hemicolectomy.*

The second indication for subtotal colectomy is the cecal diastatic perforation with the occlusive tumor in the transverse colon and the third indication for subtotal colectomy is synchronous tumors.

Extended right hemicolectomy is performed, in an emergency in about 73.7% of cases while left hemicolectomy is performed in 20% [2].
