Abstract
The patterns of presentation and associated treatments of 65 patients with acute perforated diverticulitis of the left colon have been reviewed. Four types of operations were identified: primary resection with anastomosis (group I, N=29), primary resection with anastomosis and protective colostomy (group II, N=5), primary resection with Hartmann procedure (group III, N=26), and delayed resection three-staged procedure (group IV, N=5). The severity of disease was also classified (stages I to IV). Postoperative mortality rates in the first two groups were lower than that of the Hartmann group (3.4 vs. 15.3 percent). The mean length of initial hospitalization was 16±1.2 days for group I, 18.2±4.4 days for group II, 19.4±2 days for group III, 26.4±4.4 days for group IV (P<.05,t-test group IVvs. groups I, II, and III). Complications in the Hartmann group were high with a 23 percent wound infection rate and mortality after closure of colostomy and bowel reconstruction was 3.8 percent. These data demonstrate that primary resection with anastomosis is a satisfactory operation for the majority of patients with perforated diverticulitis (stages I to III), and there appears to be no clinical indication to use the three-staged operation.
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Mayo WJ, Wilson LA, Griffin MI. Acquired diverticulitis of the large colon. Surg Gynecol Obstet 1907;5:8–15.
Lockhart-Mummery JP. Late results of diverticulitis. Lancet 1938;2:1401–4.
Smithwick RH. Experience with the surgical management of diverticulitis of the sigmoid. Ann Surg 1942;115:969–85.
Pemberton G, Black BM, Maino CR. Progress in the surgical management of diverticulitis of the sigmoid colon. Surg Gynecol Obstet 1947;85:523–34.
Rodkey GV, Welch CE. Surgical management of colonic diverticulitis with free perforation or abscess formation. Am J Surg 1969;117:265–9
Byrne JJ, Garick EI. Surgical treatment of diverticulitis. Ann J Surg 1971;121:379–84.
Graves HA Jr, Franklin RM, Robbins LBH, et al. Surgical management of perforated diverticulitis of the colon. Ann Surg 1973;39:142–7.
Nagorney DM, Adson MA, Pemberton JH. Sigmoid diverticulitis with perforation and generalized peritonitis. Dis Colon Rectum 1985;28:71–5.
Lambert ME, Knox RA, Schofield PF, Hancock BD. Management of the septic complications of diverticular disease. Br J Surg 1986;73:576–9.
Boyden AM, Neilson RO. Reappraisal of surgical treatment of diverticulitis of the sigmoid colon. Am J Surg 1960;100:206–16.
Boyden AM. Two-stage (obstructive) resection of the sigmoid in selected cases of complicated diverticulitis. Ann Surg 1961;154(suppl):210–4.
Nunes GC, Robnett AH, Kremer RM, Ahlquist RE Jr. The Hartmann procedure for complications of diverticulitis. Arch Surg 1979;114:425–9.
Risholm L. Primary resection in perforating diverticulitis of the colon. World J Surg 1982;6:490–1.
Finlay IG, Carter DC. A comparison of emergency resection and staged management in perforated diverticular disease. Dis Colon Rectum 1987;30:929–33.
Fielding LP. Management of the obstructed large bowel. In: Todd IP, Fielding LP, Dudley HAF, Pories WJ. Operative surgery series. London: Butterworths, 1983;210–30.
Belding HH. Acute perforated diverticulitis of the sigmoid colon with generalized peritonitis. Arch Surg 1957;74:511–5.
Madden JL, Tan PY. Primary resection and anastomosis in the treatment of perforated lesions of the colon with abscess or diffusing peritonitis. Surg Gynecol Obstet 1961;113:646–50.
Roxburgh RA, Dawson JL, Yeo R. Emergency resection in treatment of diverticular disease of colon complicated by peritonitis. Br Med J 1968;3:465–6.
Ryan P. Emergency resection and anastomosis for perforated sigmoid diverticulitis. Aust NZ J Surg 1974;44:16–20.
Auguste LJ, Wise L. Surgical management of perforated diverticulitis. Am J Surg 1981;141:122–7.
Alexander J, Karl RC, Skinner DB. Results of changing trends in the surgical management of complications of diverticular disease. Surgery 1983;94:683–90.
Welch CE, Welch JP. Resection and anastomosis of the colon in the presence of peritonitis. In: Delaney JP, Varco RL: Controversies in surgery II. Philadelphia: WB Saunders, 1983:352–9.
Grant V, Rodkey GV, Welch CE. Changing patterns in the surgical treatment of diverticular disease. Ann Surg 1984;200:466–78.
Auguste LJ, Wise L. Surgical management of perforated diverticulitis. Arch Surg 1985;120:450–2.
Hackford AW, Schoetz DJ Jr, Coller JA, Veidenheimer MC. Surgical management of complicated diverticulitis: the Lahey Clinic experience, 1967 to 1982. Dis Colon Rectum 1985;28:317–21.
Haglund U, Hellberg R, Johns EN, Hult RN. Complicated diverticular disease of the sigmoid colon: an analysis of short and long term outcome in 392 patients. Ann Chir Gynaecol 1979;68:41–6.
Greif JM, Fried G, McSherry CK. Surgical treatment of perforated diverticular disease of the sigmoid colon. Dis Colon Rectum 1980;23:483–7.
Killingback MJ. Acute diverticulitis: Progress report, Australasian survey (1967–69). Dis Colon Rectum 1970;13:444–7.
Botsford TW, Zollinger RM, Hicks R. Mortality of the surgical treatment of diverticulitis. Am J Surg 1971;121:702–5.
Krukowski ZH, Matheson NA. Emergency surgery for diverticular disease complicated by generalized peritonitis: A review. Br J Surg 1984;71:921–7.
Hinchey EJ, Schaal PG, Richards GK. Treatment of perforated diverticular disease of the colon. Adv Surg 1978;12:85–109.
Siegel S. Non-parametric statistics for the behavioral sciences. New York: McGraw-Hill, 1956.
Fazio VW, Church JM, Jagelman DG, et al. Colocutaneous fistulas complicating diverticulitis. Dis Colon Rectum 1987;30:89–94.
Dudley HA, Radcliffe AG, McGeehan D. Intraoperative irrigation of the colon to permit primary anastomosis. Br J Surg 1980;67:80–1.
Sakai L, Drake J, Kaminski DL. Acute perforation of sigmoid diverticula. Am J Surg 1981;142:712–6.
Wara P, Sorseson L, Berg V, Ampdrup E. The outcome of staged management of complicated diverticular disease of the sigmoid colon. Acta Chir Scand 1981;147:209–14.
Edelman G. Surgical treatment of colonic diverticulitis: a report of 205 cases. Int Surg 1981;66:119–24.
Killingback M. Management of perforated diverticulitis. Surg Clin North Am 1983;63:97–115.
Theile D. The management of perforated diverticulitis with diffuse peritonitis. Aust NZ J Surg 1980;50:47–9.
Auguste LJ, Wise L. Surgical management of perforated diverticulitis. Am J Surg 1981;141:122–7.
Liebert CW, Deweese BM. Primary resection without anastomosis for perforation of acute diverticulitis. Surg Gynecol Obstet 1981;152:30–2.
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Alanis, A., Papanicolaou, G.K., Tadros, R.R. et al. Primary resection and anastomosis for treatment of acute diverticulitis. Dis Colon Rectum 32, 933–939 (1989). https://doi.org/10.1007/BF02552268
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DOI: https://doi.org/10.1007/BF02552268