Complications resulting from colonic perforation are related to secondary peritonitis due to bacterial or fecal contamination. We investigated outcomes of emergency surgery for colonic perforation associated with fecal contamination with regard to early and late postoperative complication rates and mortality rates, and investigated prognostic factors influencing those outcomes.
A retrospective analysis of prospectively collected data on factors influencing complications and mortality rates was conducted on data from 152 patients who had undergone emergent operations for colonic perforation between January 2005 and December 2011. Patients were categorized into two groups: those with and without gross fecal contamination at the time of operation.
Forty-one (26.9 %) patients had gross fecal contamination. Patients who had fetal contamination had a higher Mannheim peritonitis index (31.3 ± 5.1 vs. 21.9 ± 7.2, p < 0.001), higher organ failure rate (53.7 vs. 24.3 %, p = 0.001), and longer operating time (168.8 ± 49.9 vs. 144.8 ± 66.1 min, p = 0.036) than patients without fecal contamination. Early complications (<30 days) occurred more frequently in the fecal contamination group (82.9 vs. 49.5 %, p = 0.001), although late complications (46.2 vs. 39.3 %, p = 0.942) and mortality (17.1 vs. 8.1 %, p = 0.110) did not differ. In multivariate analysis, fecal contamination significantly predicted early complications (odds ratio, 2.78; p = 0.037) but not late complications or mortality.
The frequency of early complications can increase if fecal contamination exists. However, when early complications are well managed, fecal contamination does not significantly influence occurrences late complications or mortality.
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Irvin GL 3rd, Horsley JS 3rd, Caruana JA Jr (1984) The morbidity and mortality of emergent operations for colorectal disease. Ann Surg 199:598–603
Runkel NS, Schlag P, Schwarz V, Herfarth C (1991) Outcome after emergency surgery for cancer of the large intestine. Br J Surg 78:183–188
Damore LJ 2nd, Rantis PC, Vernava AM 3rd, Longo WE (1996) Colonoscopic perforations. Etiology, diagnosis, and management. Dis Colon Rectum 39:1308–1314
Haque R, Huston CD, Hughes M, Houpt E, Petri WA Jr (2003) Amebiasis. N Engl J Med 348:1565–1573
Greenstein AJ, Barth JA, Sachar DB, Aufses AH Jr (1986) Free colonic perforation without dilatation in ulcerative colitis. Am J Surg 152:272–275
Gandhi SK, Hanson MM, Vernava AM, Kaminski DL, Longo WE (1996) Ischemic colitis. Dis Colon Rectum 39:88–100
Nespoli A, Ravizzini C, Trivella M, Segala M (1993) The choice of surgical procedure for peritonitis due to colonic perforation. Arch Surg 128:814–818
Demetriades D, Rabinowitz B, Sofianos C, Prumm E (1985) The management of colon injuries by primary repair or colostomy. Br J Surg 72:881–883
Schilling MK, Maurer CA, Kollmar O, Buchler MW (2001) Primary vs. secondary anastomosis after sigmoid colon resection for perforated diverticulitis (Hinchey Stage III and IV): a prospective outcome and cost analysis. Dis Colon Rectum 44:699–703, discussion -5
Constantinides VA, Tekkis PP, Athanasiou T, Aziz O, Purkayastha S, Remzi FH et al (2006) Primary resection with anastomosis vs. Hartmann's procedure in nonelective surgery for acute colonic diverticulitis: a systematic review. Dis Colon Rectum 49:966–981
Killingback M (1983) Management of perforative diverticulitis. Surg Clin N Am 63:97–115
Kriwanek S, Armbruster C, Beckerhinn P, Dittrich K (1994) Prognostic factors for survival in colonic perforation. Int J Color Dis 9:158–162
Wittmann DH, Schein M, Condon RE (1996) Management of secondary peritonitis. Ann Surg 224:10–18
Edna TH, Jamal Talabani A, Lydersen S, Endreseth BH (2014) Survival after acute colon diverticulitis treated in hospital. Int J Color Dis 29:1361–1367
Billing A, Frohlich D, Schildberg FW (1994) Prediction of outcome using the Mannheim peritonitis index in 2003 patients. Peritonitis Study Group. Br J Surg 81:209–213
Sundararajan V, Henderson T, Perry C, Muggivan A, Quan H, Ghali WA (2004) New ICD-10 version of the Charlson comorbidity index predicted in-hospital mortality. J Clin Epidemiol 57:1288–1294
Alamili M, Gogenur I, Rosenberg J (2009) Acute complicated diverticulitis managed by laparoscopic lavage. Dis Colon Rectum 52:1345–1349
Myers E, Hurley M, O’Sullivan GC, Kavanagh D, Wilson I, Winter DC (2008) Laparoscopic peritoneal lavage for generalized peritonitis due to perforated diverticulitis. Br J Surg 95:97–101
Franklin ME Jr, Portillo G, Trevino JM, Gonzalez JJ, Glass JL (2008) Long-term experience with the laparoscopic approach to perforated diverticulitis plus generalized peritonitis. World J Surg 32:1507–1511
Mazza D, Chio F, Khoury-Helou A (2009) Conservative laparoscopic treatment of diverticular peritonitis. J Chir (Paris) 146:265–269
Taylor CJ, Layani L, Ghusn MA, White SI (2006) Perforated diverticulitis managed by laparoscopic lavage. ANZ J Surg 76:962–965
Garg PK, Kumar A, Sharda VK, Saini A, Garg A, Sandhu A (2013) Evaluation of intraoperative peritoneal lavage with super-oxidized solution and normal saline in acute peritonitis. Arch Int Surg 3:43–48
Edmiston CE Jr, Goheen MP, Kornhall S, Jones FE, Condon RE (1990) Fecal peritonitis: microbial adherence to serosal mesothelium and resistance to peritoneal lavage. World J Surg 14:176–183
Sugimoto K, Hirata M, Kikuno T, Takishima T, Maekawa K, Ohwada T (1995) Large-volume intraoperative peritoneal lavage with an assistant device for treatment of peritonitis caused by blunt traumatic rupture of the small bowel. J Trauma-Injury Infect Crit Care 39:689–692
Kumar A, Roberts D, Wood KE, Light B, Parrillo JE, Sharma S et al (2006) Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock. Crit Care Med 34:1589–1596
Koruth NM, Krukowski ZH, Youngson GG, Hendry WS, Logie JR, Jones PF et al (1985) Intra-operative colonic irrigation in the management of left-sided large bowel emergencies. Br J Surg 72:708–711
Alves A, Panis Y, Mathieu P, Mantion G, Kwiatkowski F, Slim K (2005) Postoperative mortality and morbidity in French patients undergoing colorectal surgery: results of a prospective multicenter study. Arch Surg 140:278–283
Ryoo SB, Oh HK, Ha HK, Moon SH, Choe EK, Park KJ (2014) The outcomes and prognostic factors of surgical treatment for ischemic colitis: what can we do for a better outcome? Hepatogastroenterology 61:336–342
Dellinger RP, Levy MM, Rhodes A, Annane D, Gerlach H, Opal SM et al (2013) Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock, 2012. Intensive Care Med 39:165–228
Rivers E, Nguyen B, Havstad S, Ressler J, Muzzin A, Knoblich B et al (2001) Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med 345:1368–1377
Lerolle N, Nochy D, Guerot E, Bruneval P, Fagon JY, Diehl JL et al (2010) Histopathology of septic shock induced acute kidney injury: apoptosis and leukocytic infiltration. Intensive Care Med 36:471–478
Wu WC, Smith TS, Henderson WG, Eaton CB, Poses RM, Uttley G et al (2010) Operative blood loss, blood transfusion, and 30-day mortality in older patients after major noncardiac surgery. Ann Surg 252:11–17
Bernard AC, Davenport DL, Chang PK, Vaughan TB, Zwischenberger JB (2009) Intraoperative transfusion of 1 U to 2 U packed red blood cells is associated with increased 30-day mortality, surgical-site infection, pneumonia, and sepsis in general surgery patients. J Am Coll Surg 208: 931-7, 7 e1-2; discussion 8-9.
Raghavan M, Marik PE (2005) Anemia, allogenic blood transfusion, and immunomodulation in the critically ill. Chest 127:295–307
Carson JL, Duff A, Poses RM, Berlin JA, Spence RK, Trout R et al (1996) Effect of anaemia and cardiovascular disease on surgical mortality and morbidity. Lancet 348:1055–1060
Pisanu A, Cois A, Uccheddu A (2004) Surgical treatment of perforated diverticular disease: evaluation of factors predicting prognosis in the elderly. Int Surg 89:35–38
Biondo S, Ramos E, Deiros M, Rague JM, De Oca J, Moreno P et al (2000) Prognostic factors for mortality in left colonic peritonitis: a new scoring system. J Am Coll Surg 191:635–642
Shinkawa H, Yasuhara H, Naka S, Yanagie H, Nojiri T, Furuya Y et al (2003) Factors affecting the early mortality of patients with nontraumatic colorectal perforation. Surg Today 33:13–17
Notash AY, Salimi J, Rahimian H, Fesharaki M, Abbasi A (2005) Evaluation of Mannheim peritonitis index and multiple organ failure score in patients with peritonitis. Indian J Gastroenterol 24:197–200
Horiuchi A, Watanabe Y, Doi T, Sato K, Yukumi S, Yoshida M et al (2007) Evaluation of prognostic factors and scoring system in colonic perforation. World J Gastroenterol 13:3228–3231
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The authors declare that they have no conflicts of interest related to the publication of this article.
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Han, E.C., Ryoo, S., Park, B.K. et al. Surgical outcomes and prognostic factors of emergency surgery for colonic perforation: would fecal contamination increase morbidity and mortality?. Int J Colorectal Dis 30, 1495–1504 (2015). https://doi.org/10.1007/s00384-015-2315-6
- Colonic perforation
- Fecal contamination
- Risk factors