Rarely, when multiple walled-off perforations are found at laparotomy or when the patient is critically septic or with prohibitive comorbidities, in the presence of long-standing distension of the colon and in case of an inexperienced surgeon, a decompressive procedure is advocated, as described by Turnbull et al. . Blowhole colostomy with loop ileostomy is also recommended during pregnancy, for high-lying splenic flexure leading to the possibility of iatrogenic perforation with diffuse faecal contamination or for sealed perforation with impending risk of disruption during bowel dissection. This surgical option can be also considered if the diagnosis has not been cleared. Turnbull's operation is contraindicated in case of free perforation, abscess or hemorrhage. This operation is essentially a temporary decompression procedure bridging to a safe, definitive procedure.
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