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Primary resection with and without anastomosis for perforation of acute diverticulitis.
Acta Chir Belg. 1993 Jul-Aug; 93(4):169-72.AC

Abstract

The results of management of perforated large bowel diverticulitis were retrospectively studied over a 7-year period. 38 patients underwent operation, 20 for generalized peritonitis, 12 for local peritonitis, 5 for colovesical fistula and 1 for colovaginal fistula. The mean age of patients was 63 years (range 30-85 years). Depending on the symptoms, the spreading of the peritonitis and associated cardiovascular and pulmonary disease and diabetes mellitus, 4 types of operation were performed: primary left hemicolectomy and anastomosis with and without defunctioning colostomy, Hartmann procedure, suture and drainage with diverting colostomy. The overall mortality was 10.5%: resection and primary anastomosis entailed 3.8% mortality (1 case), while 3 deaths were observed in the 8 patients group having underwent an Hartmann procedure (37.5%). Drainage and/or diverting colostomy performed in 5 patients entailed no hospital mortality, but was followed by a 80% complication rate, requiring reoperation and several hospital admissions. The low mortality and morbidity rates obtained in the group having primary resection and anastomosis encourage wider application of this operation for perforated acute diverticulitis. Even the Hartmann procedure allows removal of the diseased colon but in a great proportion of cases reconstitution of continuity is not performed; nevertheless staged operation entailing major mortality and morbidity, expose these aged patients to remarkable hazard. Prerequisite of safe primary excision and anastomosis is vigorous intraperitoneal lavage and drainage, by the case associated to on table large bowel irrigation if concomitant obstruction is present.

Authors+Show Affiliations

1st Department of Surgery, Ospedale Santa Corona, Pietra L, Italy.No affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

8237231

Citation

Saccomani, G E., et al. "Primary Resection With and Without Anastomosis for Perforation of Acute Diverticulitis." Acta Chirurgica Belgica, vol. 93, no. 4, 1993, pp. 169-72.
Saccomani GE, Santi F, Gramegna A. Primary resection with and without anastomosis for perforation of acute diverticulitis. Acta Chir Belg. 1993;93(4):169-72.
Saccomani, G. E., Santi, F., & Gramegna, A. (1993). Primary resection with and without anastomosis for perforation of acute diverticulitis. Acta Chirurgica Belgica, 93(4), 169-72.
Saccomani GE, Santi F, Gramegna A. Primary Resection With and Without Anastomosis for Perforation of Acute Diverticulitis. Acta Chir Belg. 1993;93(4):169-72. PubMed PMID: 8237231.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Primary resection with and without anastomosis for perforation of acute diverticulitis. AU - Saccomani,G E, AU - Santi,F, AU - Gramegna,A, PY - 1993/7/1/pubmed PY - 1993/7/1/medline PY - 1993/7/1/entrez SP - 169 EP - 72 JF - Acta chirurgica Belgica JO - Acta Chir. Belg. VL - 93 IS - 4 N2 - The results of management of perforated large bowel diverticulitis were retrospectively studied over a 7-year period. 38 patients underwent operation, 20 for generalized peritonitis, 12 for local peritonitis, 5 for colovesical fistula and 1 for colovaginal fistula. The mean age of patients was 63 years (range 30-85 years). Depending on the symptoms, the spreading of the peritonitis and associated cardiovascular and pulmonary disease and diabetes mellitus, 4 types of operation were performed: primary left hemicolectomy and anastomosis with and without defunctioning colostomy, Hartmann procedure, suture and drainage with diverting colostomy. The overall mortality was 10.5%: resection and primary anastomosis entailed 3.8% mortality (1 case), while 3 deaths were observed in the 8 patients group having underwent an Hartmann procedure (37.5%). Drainage and/or diverting colostomy performed in 5 patients entailed no hospital mortality, but was followed by a 80% complication rate, requiring reoperation and several hospital admissions. The low mortality and morbidity rates obtained in the group having primary resection and anastomosis encourage wider application of this operation for perforated acute diverticulitis. Even the Hartmann procedure allows removal of the diseased colon but in a great proportion of cases reconstitution of continuity is not performed; nevertheless staged operation entailing major mortality and morbidity, expose these aged patients to remarkable hazard. Prerequisite of safe primary excision and anastomosis is vigorous intraperitoneal lavage and drainage, by the case associated to on table large bowel irrigation if concomitant obstruction is present. SN - 0001-5458 UR - https://www.unboundmedicine.com/medline/citation/8237231/Primary_resection_with_and_without_anastomosis_for_perforation_of_acute_diverticulitis_ L2 - http://www.diseaseinfosearch.org/result/9681 DB - PRIME DP - Unbound Medicine ER -