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Urgent surgery for complicated colonic diverticula.
J Gastrointestin Liver Dis 2006; 15(1):37-40JG

Abstract

The AIM of this retrospective study was to evaluate the emergency surgical treatment of life-threatening complications of colonic diverticula.

MATERIAL AND METHOD

In the last 11 years, 22 of 101 patients with colonic diverticula (22.1%) underwent urgent surgery for acute complications: perforated gangrenous diverticulitis with generalized peritonitis (n=8) or pericolic abscess (n=8), acute bowel obstruction (n=4) and severe diverticular bleeding (n=2). In all patients with diffuse peritonitis or acute obstruction the indication for surgery was decided on clinical basis and the complicated diverticula were recognized only intra-operatively.

RESULTS

Emergency surgical strategy differed according to the type of complication and the biologic condition of the patient: segmental colectomy and primary anastomosis for diverticular perforation (n=4), colonic stenosis (n=3) or diverticular bleeding (n=2); Hartmann resection with late reconnecting anastomosis in patients with diverticular perforation (n=5) or colonic obstruction (n=1); diverticulectomy with peritoneal drainage (n=2) and colostomy and drainage followed by secondary colectomy (n=5) for diverticular perforations in patients with poor general condition. Only one patient (4.5%) died post-operatively of multiple organ failure from generalized peritonitis. There was no anastomotic leakage in patients with primary anastomosis. Six patients (27.2%) developed wound infection. Hospital stay ranged between 11 and 60 days, significantly longer in cases with two-stage operations.

CONCLUSION

Primary colectomy with immediate or delayed anastomosis is the best surgical procedure for acute divericular complications in patients with good biologic status. Two-stage operations such as colostomy and drainage coupled with late colectomy remain the viable alternative in patients with advanced disease and critical biologic condition.

Authors+Show Affiliations

1st Surgical Clinic, University of Medicine and Pharmacy, Cluj-Napoca, Romania. g.funariu@email.roNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

16680231

Citation

Funariu, Gheorghe, et al. "Urgent Surgery for Complicated Colonic Diverticula." Journal of Gastrointestinal and Liver Diseases : JGLD, vol. 15, no. 1, 2006, pp. 37-40.
Funariu G, Binţinţan V, Seicean R. Urgent surgery for complicated colonic diverticula. J Gastrointestin Liver Dis. 2006;15(1):37-40.
Funariu, G., Binţinţan, V., & Seicean, R. (2006). Urgent surgery for complicated colonic diverticula. Journal of Gastrointestinal and Liver Diseases : JGLD, 15(1), pp. 37-40.
Funariu G, Binţinţan V, Seicean R. Urgent Surgery for Complicated Colonic Diverticula. J Gastrointestin Liver Dis. 2006;15(1):37-40. PubMed PMID: 16680231.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Urgent surgery for complicated colonic diverticula. AU - Funariu,Gheorghe, AU - Binţinţan,Vasile, AU - Seicean,Radu, PY - 2006/5/9/pubmed PY - 2006/6/21/medline PY - 2006/5/9/entrez SP - 37 EP - 40 JF - Journal of gastrointestinal and liver diseases : JGLD JO - J Gastrointestin Liver Dis VL - 15 IS - 1 N2 - UNLABELLED: The AIM of this retrospective study was to evaluate the emergency surgical treatment of life-threatening complications of colonic diverticula. MATERIAL AND METHOD: In the last 11 years, 22 of 101 patients with colonic diverticula (22.1%) underwent urgent surgery for acute complications: perforated gangrenous diverticulitis with generalized peritonitis (n=8) or pericolic abscess (n=8), acute bowel obstruction (n=4) and severe diverticular bleeding (n=2). In all patients with diffuse peritonitis or acute obstruction the indication for surgery was decided on clinical basis and the complicated diverticula were recognized only intra-operatively. RESULTS: Emergency surgical strategy differed according to the type of complication and the biologic condition of the patient: segmental colectomy and primary anastomosis for diverticular perforation (n=4), colonic stenosis (n=3) or diverticular bleeding (n=2); Hartmann resection with late reconnecting anastomosis in patients with diverticular perforation (n=5) or colonic obstruction (n=1); diverticulectomy with peritoneal drainage (n=2) and colostomy and drainage followed by secondary colectomy (n=5) for diverticular perforations in patients with poor general condition. Only one patient (4.5%) died post-operatively of multiple organ failure from generalized peritonitis. There was no anastomotic leakage in patients with primary anastomosis. Six patients (27.2%) developed wound infection. Hospital stay ranged between 11 and 60 days, significantly longer in cases with two-stage operations. CONCLUSION: Primary colectomy with immediate or delayed anastomosis is the best surgical procedure for acute divericular complications in patients with good biologic status. Two-stage operations such as colostomy and drainage coupled with late colectomy remain the viable alternative in patients with advanced disease and critical biologic condition. SN - 1841-8724 UR - https://www.unboundmedicine.com/medline/citation/16680231/Urgent_surgery_for_complicated_colonic_diverticula_ L2 - http://www.jgld.ro/2006/1/6.html DB - PRIME DP - Unbound Medicine ER -