A Paul-Mikulicz procedure is used to treat obstructed colonic carcinoma, volvulus or localized diverticular disease. It must only be attempted if both limbs of the stoma can be brought to the skin.
For example, in left-sided colonic carcinoma, the descending and sigmoid colon is mobilised and the tumour brought out through a muscle cutting incision in the left iliac fossa. It is then resected outside the abdomen. The two affected segments of bowel are then sewn to each other along the antimesenteric border. The tissue between the now double-barrelled tube is crushed and joined using a side-to-side stapler. The mucosae of the two limbs are sutured to the skin.
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