直肠癌Hartmann术后直肠残端坏死穿孔并发小肠梗阻是非常罕见的严重并发症。本文回顾性分析1例直肠癌行腹腔镜Hartmann术后直肠残端坏死穿孔、低位完全性小肠梗阻的诊治过程和再手术情况。总结得在出术前术中应对直肠癌局部及全身情况进行充分评估，不能切除者可以考虑放化疗降期后再手术；不论采用开放还是腹腔镜下手术，都应该严格遵循规范，能够根治性切除的直肠癌应按全直肠系膜切除（TME）的标准手术；术中探查确定直肠癌已无法切除者，宜选择乙状结肠襻式双腔造口术。

After Hartmann′s operation, it is very rare and serious complications for necrosis and perforation of rectal stump with small intestinal obstruction. The diagnosis, treatment and reoperation of a case with necrosis and perforation of rectal stump with complete low intestinal obstruction after laparoscopic Hartmann′s operation were analyzed. We can draw a conclusion that before operation, the local and systemic conditions of rectal cancer should be fully evaluated; Those who can′t be resected can consider operating after radiotherapy and chemotherapy; Whether open or laparoscopic operation is used, the standard should be strictly followed, rectal cancer that can be resected radically should be operated according to the standard of total mesorectal excision (TME); Those who can′t be resected by exploration during operation should choose double lumen loop colostomy.