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Emergency surgery for complicated diverticular disease

A five-year experience

  • Original Contributions
  • Published:
Diseases of the Colon & Rectum

Abstract

Ninety-three patients who underwent surgery were studied retrospectively over a five-year period for complications of diverticular disease, including free perforation in 32 patients (with fecal peritonitis in S), inflammation or peritonitis in 22 patients, an abscess in 11 patients, and intestinal obstruction in 14 patients. Sixty-eight patients (73 percent) had systemic symptoms and signs consistent with serious sepsis. There has been a growing popularity of the Hartmann procedure throughout the study period. The overall 30-day mortality rate was 10.8 percent. Because of a high proportion of poor-risk patients, the Hartmann group fared particularly badly compared with-those who had other operations, with a 28 percent mortality rate, 69 percent incidence of major complications, and one third of the survivors having a permanent colostomy. Other operative procedures are discussed, but until prospective data become available, it is unlikely that the widespread popularity of the Hartmann procedure will decline. Therefore, the importance of meticulous attention to technical detail is stressed if results are to improve.

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References

  1. 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.

    PubMed  CAS  Google Scholar 

  2. Lambert ME, Knox RA, Schofield PF, Hancock BD. Management of the septic complications of diverticular disease. Br J Surg 1986;73:576–9.

    PubMed  CAS  Google Scholar 

  3. Shephard AA, Keighley MR. Audit on complicated diverticular disease. Ann R Coll Surg Engl 1986;68:8–11.

    PubMed  CAS  Google Scholar 

  4. Krukowski ZH, Matheson NA. Emergency surgery for diverticular disease complicated by generalized and faecal peritonitis: a review. Br J Surg 1984;71:921–7.

    PubMed  CAS  Google Scholar 

  5. Underwood JW, Marks CG. The septic complications of sigmoid diverticular disease. Br J Surg 1984;71:209–11.

    PubMed  CAS  Google Scholar 

  6. Kjaergaard J, Fischer AB, Baden H. Hartmann's operation as an emergency procedure for perforation of the sigmoid colon. Acta Chir Scand 1984;150:255–7.

    PubMed  CAS  Google Scholar 

  7. Drumm J, Clain A. The management of acute colonic diverticulitis with suppurative peritonitis. Ann R Coll Surg Engl 1984;66: 90–1.

    PubMed  CAS  Google Scholar 

  8. Alexander J, Karl RC, Skinner DB. Results of changing trends in the surgical management of complications of diverticular disease. Surgery 1983;94:683–8.

    PubMed  CAS  Google Scholar 

  9. Hyland JM, Taylor I. Does a high fibre diet prevent the complications of diverticular disease?. Br J Surg 1980;67:77–9.

    PubMed  CAS  Google Scholar 

  10. Finlay IG, Carter DC. A comparison of emergency resection and staged management in perforated diverticular disease. Dis Colon Rectum 1987;30:929–33.

    Article  PubMed  CAS  Google Scholar 

  11. Krukowski ZH, Koruth NM, Matheson NA. Fvolving practice in acute diverticulitis. Br J Surg 1985;72:684–6.

    PubMed  CAS  Google Scholar 

  12. Rodkey GV, Welch CE. Changing patterns in the surgical treatment of diverticular disease. Ann Surg 1984;200:466–77.

    Article  PubMed  CAS  Google Scholar 

  13. Gregg RO. An ideal operation for diverticulitis of the colon. Am J Surg 1987;153:285–90.

    Article  PubMed  CAS  Google Scholar 

  14. Hulkko OA, Laitinen ST, Haukipuro KA, Stahlberg MJ, Juvonen TS, Kairaluoma MI. The Hartmann procedure for the treatment of colorectal emergencies. Acta Chir Scand 1986;152:531–5.

    PubMed  CAS  Google Scholar 

  15. Mittal VK, Cortez JA. Hartmann procedure reconstruction with EFA stapler. Dis Colon Rectum 1981;24:215–6.

    PubMed  CAS  Google Scholar 

  16. Sloan MS, Krebs HB, Wheelock JB. A simplified technique for intestinal reanastomosis after the Hartmann procedure. Surg Gynecol Obstet 1985;161:391–2.

    Google Scholar 

  17. Dudley HA, Radcliffe AG, McGeehan D. Intraoperative irrigation of the colon to permit primary anastomosis. Br J Surg 1980; 67:80–1.

    PubMed  CAS  Google Scholar 

  18. Koruth NM, Krukowski ZH, Youngson GG, et al. Intra-operative colonic irrigation in the management of left sided large bowel emergencies. Br J Surg 1985;72:708–11.

    PubMed  CAS  Google Scholar 

  19. Foster ME, Johnson CD, Billings PJ, Davies PW, Leaper DJ. Intraoperative antegrade lavage and anastomotic healing in acute colonic obstruction. Dis Colon Rectum 1986;29:255–259.

    Article  PubMed  CAS  Google Scholar 

  20. Pollock AV, Playforth MJ, Evans M. Peroperative lavage of the obstructed left colon to allow safe primary anastomosis. Dis Colon Rectum 1987;30:171–3.

    PubMed  CAS  Google Scholar 

  21. Saini S, Mueller PR, Wittenberg J, et al. Percutaneous drainage of diverticular abscess. Arch Surg 1986;121:475–8.

    PubMed  CAS  Google Scholar 

  22. Neff CC, vanSonnenberg E, Casola G, et al. Diverticular abscesses: percutaneous drainage. Radiology 1987;163:15–8.

    PubMed  CAS  Google Scholar 

  23. Mueller PR, Saini S, Wittenberg J, et al. Sigmoid diverticular abscesses: percutaneous drainage as an adjunct to surgical resection in 24 cases. Radiology 1987;164:321–5.

    PubMed  CAS  Google Scholar 

  24. Schein M, Decker G. The Hartmann procedure: extended indications in severe intra-abdominal infection. Dis Colon Rectum 1988;31:126–9.

    PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Surgery, John Radcliffe Hospital, OX3 9DU, Oxford, UK

    A. R. Berry Ch.M., F.R.C.S., W. H. Turner F.R.C.S., N. J. McC Mortensen M.D., F.R.C.S. & M. G. W. Kettlewell M.S., F.R.C.S.

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  1. A. R. Berry Ch.M., F.R.C.S.
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  2. W. H. Turner F.R.C.S.
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  3. N. J. McC Mortensen M.D., F.R.C.S.
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  4. M. G. W. Kettlewell M.S., F.R.C.S.
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Berry, A.R., Turner, W.H., Mortensen, N.J.M. et al. Emergency surgery for complicated diverticular disease. Dis Colon Rectum 32, 849–854 (1989). https://doi.org/10.1007/BF02554554

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