Background: Major left colonic emergencies are a paramount surgical challenge to surgeons. Surgical options include Hartmann procedure (HP), resection anastomosis with covering colostomy or ileostomy (two-stage procedure) and primary resection anastomosis with on-table bowel preparation (one-stage procedure). Surgical modalities were evaluated in a multicenter study in three centers in Egypt, Kingdom of Saudi Arabia and Nigeria. Patients and methods: This study was conducted prospectively including 105 patients operated at three different centers: Zagazig University Hospital in Egypt (51 cases); King Abdullah Hospital KSA (37 cases); and Dalhatu Araf Specialist Hospital, Nigeria (17 cases). The 3 modalities of surgical procedures practiced were Hartmann procedure, resection anastomosis with covering colostomy or ileostomy and primary resection anastomosis with on-table bowel preparation. Results: Of the 105 patients with left colonic emergencies , 34 patients (32.4%) had Hartman procedure, 35 patients (33.3%) had resection anastomosis with covering colostomy or ileostomy and 36 patients (34.3%) had primary resection anastomosis with on-table bowel preparation. Operative and postoperative data were collected, and a comparative study was performed. Mortality rates of resection with primary anastomosis (one-stage), resection anastomosis with covering colostomy, and resection with Hartmann procedure (2-stage procedure) groups was 8.1 %, 3.2% and 3.3%, respectively. The mortality rates in the one-stage procedure group was statistically higher than that of the two-stage procedure group (p = 0.04). Complication rate of one stage procedure was slightly higher than in two-stage procedure (22.2% vs.14.7 and 17.1% respectively). Conclusions: Left colonic emergencies are a common surgical challenge. HP, resection anastomosis with covering colostomy or ileostomy and primary resection anastomosis with on-table bowel preparation are surgical options. Surgical option depends on operative findings, patient’s condition and surgeon’s expertise and preference. Keywords: left colorectal emergencies, Hartmann procedure, two-stage colonic procedure, one-stage colonic procedure