Background: Although acute obstruction of the right colon is usually dealt with by primary anastomosis following resection, many surgeons are reluctant to offer one stage resection and anastomosis to patients with obstructive lesions of the left colon. Aim: The aim of the study is to compare the result of one stage resection and anastomosis for patients with acute complete obstruction due to left colon cancer versus Hartman's procedure. Patients and methods: Eighty four patients with acute left colonic obstruction presented to Sohag University Hospital between march 2008 and February 2012. The diagnosis was based on clinical evidence of obstruction and radiological features of left colonic obstruction on plain x-ray abdomen. No pre-operative histopathological  confirmation   of  the diagnosis was done for all patients. Thirty eight patients were managed by one stage left colectomy  without intra­ operative lavage (only manual evacuation of colon and mobbing of the two ends of anastomosis). Hartmann's  procedure was performed in thirty four patients. Twelve patients were excluded from the study according to the following criteria: 1- patients with inoperaple tumors (liver metastasis, peritoneal seedling, haemorrhagic ascitis or unresectable). 2-medically unfit or haemodynamiclly  unstable patients. 3- colonic perforation or peritonitis. Results: As regards the post operative complications related to left sided colonic surgery (wound   sepsis,  intra-peritoneal   sepsis,  anastomotic   leakage),   there  were  no  significant difference between the two techniques