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Benefits of laparoscopic peritoneal lavage for complicated sigmoid diverticulitis

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Background

The traditional therapy for perforated sigmoid diverticulitis with peritonitis is emergency colectomy usually with colostomy. We report laparoscopic exploration with peritoneal lavage as an alternative in seven patients who required emergency surgery for diverticulitis.

Methods

Six patients presented with diffuse peritonitis and one with a failure of percutaneous therapy. All patients were explored laparoscopically and the peritoneal cavity was lavaged with saline in addition to receiving intravenous antibiotics. Patient demographics, clinical response, length of stay, and complications were recorded.

Results

Six patients had resolution of peritonitis resolved and patients were discharged from the hospital. One of these patients who developed a pelvic abscess required a percutaneous drainage postoperatively. This patient ultimately returned 3 months later with recurrent symptoms and underwent colectomy with primary anastomosis. One patient failed to improve initially and underwent colectomy with primary anastomosis on the same admission. Five patients subsequently had elective sigmoid resections, four laparoscopic and one open. Mean length of stay was 7.7 days. There was no mortality.

Conclusion

We conclude that laparoscopic exploration and peritoneal lavage can be performed safely in patients with diffuse, purulent peritonitis. Using this approach, most patients with purulent peritonitis can avoid emergent laparotomy with the risk of colostomy, and the need for a second surgery.

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Authors and Affiliations

  1. Department of Surgery, Lowell General Hospital, 295 Varnum Ave., Lowell, MA, 01854, USA

    John C. Friel

  2. Department of Surgery, UMass Memorial Medical Center, 55 Lake Ave. N., Worcester, MA, 01655, USA

    John J. Kelly & Richard Perugini

  3. Department of Surgery, Berkshire Medical Center, 725 North Street, Pittsfield, MA, 01201, USA

    Joanne Favuzza & Timothy C. Counihan

Authors
  1. Joanne Favuzza
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  2. John C. Friel
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  3. John J. Kelly
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  4. Richard Perugini
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  5. Timothy C. Counihan
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Corresponding author

Correspondence to Timothy C. Counihan.

Additional information

The corresponding author had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. This work was conducted at UMass Memorial Medical Center and was approved by the Institutional Review Board.

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Favuzza, J., Friel, J.C., Kelly, J.J. et al. Benefits of laparoscopic peritoneal lavage for complicated sigmoid diverticulitis. Int J Colorectal Dis 24, 797–801 (2009). https://doi.org/10.1007/s00384-009-0641-2

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