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[Peritonitis in diverticulitis: the Bern concept].
Zentralbl Chir. 1998; 123(12):1394-9.ZC

Abstract

INTRODUCTION

The colon is the most frequent origine for a diffuse peritonitis and diverticular perforation is again the most common source of a spontaneous secondary peritonitis. This paper first focuses on the treatment of peritonitis and secondly on the strategies of source control in peritonitis with special emphasis on the tactics (primary anastomosis vs. Hartmann procedure with colostomy) for surgical source control.

PATIENT AND METHODS

Prospective analysis of 404 patients suffering from peritonitis (11/93-2/98), treated with an uniform treatment concept including early operation, source control and extensive intraoperative lavage (20 to 30 liters) as a standard procedure. Other treatment measures were added in special indications "on demand" only. Peritonitis was graded with the Mannheim Peritonitis Index (MPI). Tactics of source control in peritonitis due to diverticulitis were performed according to "general condition" respectively the MPI of the patient.

RESULTS

The 404 patients averaged a MPI of 19 (0-35) in "local" peritonitis and a MPI of 26 (11-43) in "diffuse" peritonitis. The colon as a source of peritonitis resulted in MPI of 16 (0-33) in the case of "local" respectively 27 (11-43) in "diffuse" peritonitis. From 181 patients suffering from diverticulitis 144 needed an operation and in 78 (54%) peritonitis was present. Fourty-six percent (36) of the patients suffered from "local", 54% (42) from "diffuse" peritonitis. Resection with primary anastomosis was performed in 26% (20/78) whereas in 74% (58/78) of the patients a Hartmann procedure with colostomy was performed. The correlating MPI was 16 (0-28) vs. 23 (16-27) respectively. The analysis of complications and mortality based on the MPI showed a decent discrimination potential for primary anastomosis vs Hartmann procedure: morbidity 35% vs. 41%; reoperation 5% vs. 5%; mortality 0% vs. 14%.

CONCLUSION

In case of peritonitis due to diverticulitis the treatment of peritonitis comes first. Thanks to advances in intensive care and improved anti-inflammatory care, a more conservative surgical concept nowadays is accepted. In the case of diverticulitis the MPI is helpful to choose between primary anastomosis vs. Hartmann procedure with colostomy as source control. The MPI includes the "general condition" of the patient into the tactical decision how to attain source control.

Authors+Show Affiliations

Klinik für Viszerale und Transplantationschirurgie, Universität Bern, Inselspital.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

English Abstract
Journal Article

Language

ger

PubMed ID

10063552

Citation

Seiler, C A., et al. "[Peritonitis in Diverticulitis: the Bern Concept]." Zentralblatt Fur Chirurgie, vol. 123, no. 12, 1998, pp. 1394-9.
Seiler CA, Brügger L, Maurer CA, et al. [Peritonitis in diverticulitis: the Bern concept]. Zentralbl Chir. 1998;123(12):1394-9.
Seiler, C. A., Brügger, L., Maurer, C. A., Renzulli, P., & Büchler, M. W. (1998). [Peritonitis in diverticulitis: the Bern concept]. Zentralblatt Fur Chirurgie, 123(12), 1394-9.
Seiler CA, et al. [Peritonitis in Diverticulitis: the Bern Concept]. Zentralbl Chir. 1998;123(12):1394-9. PubMed PMID: 10063552.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - [Peritonitis in diverticulitis: the Bern concept]. AU - Seiler,C A, AU - Brügger,L, AU - Maurer,C A, AU - Renzulli,P, AU - Büchler,M W, PY - 1999/3/4/pubmed PY - 1999/3/4/medline PY - 1999/3/4/entrez SP - 1394 EP - 9 JF - Zentralblatt fur Chirurgie JO - Zentralbl Chir VL - 123 IS - 12 N2 - INTRODUCTION: The colon is the most frequent origine for a diffuse peritonitis and diverticular perforation is again the most common source of a spontaneous secondary peritonitis. This paper first focuses on the treatment of peritonitis and secondly on the strategies of source control in peritonitis with special emphasis on the tactics (primary anastomosis vs. Hartmann procedure with colostomy) for surgical source control. PATIENT AND METHODS: Prospective analysis of 404 patients suffering from peritonitis (11/93-2/98), treated with an uniform treatment concept including early operation, source control and extensive intraoperative lavage (20 to 30 liters) as a standard procedure. Other treatment measures were added in special indications "on demand" only. Peritonitis was graded with the Mannheim Peritonitis Index (MPI). Tactics of source control in peritonitis due to diverticulitis were performed according to "general condition" respectively the MPI of the patient. RESULTS: The 404 patients averaged a MPI of 19 (0-35) in "local" peritonitis and a MPI of 26 (11-43) in "diffuse" peritonitis. The colon as a source of peritonitis resulted in MPI of 16 (0-33) in the case of "local" respectively 27 (11-43) in "diffuse" peritonitis. From 181 patients suffering from diverticulitis 144 needed an operation and in 78 (54%) peritonitis was present. Fourty-six percent (36) of the patients suffered from "local", 54% (42) from "diffuse" peritonitis. Resection with primary anastomosis was performed in 26% (20/78) whereas in 74% (58/78) of the patients a Hartmann procedure with colostomy was performed. The correlating MPI was 16 (0-28) vs. 23 (16-27) respectively. The analysis of complications and mortality based on the MPI showed a decent discrimination potential for primary anastomosis vs Hartmann procedure: morbidity 35% vs. 41%; reoperation 5% vs. 5%; mortality 0% vs. 14%. CONCLUSION: In case of peritonitis due to diverticulitis the treatment of peritonitis comes first. Thanks to advances in intensive care and improved anti-inflammatory care, a more conservative surgical concept nowadays is accepted. In the case of diverticulitis the MPI is helpful to choose between primary anastomosis vs. Hartmann procedure with colostomy as source control. The MPI includes the "general condition" of the patient into the tactical decision how to attain source control. SN - 0044-409X UR - https://www.unboundmedicine.com/medline/citation/10063552/[Peritonitis_in_diverticulitis:_the_Bern_concept]_ L2 - http://www.diseaseinfosearch.org/result/9681 DB - PRIME DP - Unbound Medicine ER -