Among patients who undergo sigmoid colectomy with end colostomy and out of circuit rectum (Hartmann’s operation), many will not have additional surgery to restore intestinal continuity. Predictors of nonreversal include: advanced age, elevated American Society of Anesthesiologists (ASA) classification, pulmonary comorbidity, perforation, and need for anticoagulants. Colostomy reversal after Hartmann’s operation can be difficult because of adhesions, altered anatomy, and injury to neighboring structures.