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Major acute inflammatory complications of diverticular disease of the colon: planning of surgical management.
Hepatogastroenterology. 1996 Jul-Aug; 43(10):839-45.H

Abstract

BACKGROUND/AIMS

The aim of this study was to determine the most appropriate surgical strategy in the management of patients with major inflammatory complications of colonic diverticular disease.

MATERIALS AND METHODS

Out of 259 patients affected by complicated diverticular disease of the colon, 43 consecutive patients (16.6%) who underwent urgent or emergency surgical intervention for diverticular perforation during a 20-year period (1975-1994) were retrospectively analyzed. According to the changes in the surgical approach over the time, the series was divided into two groups: 1975-1985 group A (n = 23), 1986-1994 group B (n = 20). The clinical diagnosis was confirmed by operative and pathologic findings.

RESULTS

Out of 43 patients, 11 underwent derivative procedure and 32 resection. There were no significant differences among the two groups of patients according to sex ratio and mean age. The overall percentage of patients in group B who underwent resective procedure (100%) was significantly greater in comparison with that in group A (52%) (p < 0.001). Colostomy and drainage was employed only during the first period (30%)(vs group B, p < 0.05) and the proportion of patients who underwent primary resection and anastomosis was significantly higher during the second period (45%) (vs group A, p < 0.05).

CONCLUSIONS

It must be stressed that resection of the diseased segment at initial operation appears mandatory; one-stage procedure is indicated when infection is confined to the mesentery, while resection and anastomosis with covering colostomy (two-stage procedure) is preferable whenever peritoneal contamination has occurred. Hartmann's operation remains the procedure of choice in the patients presenting known impaired immunity or fecal contamination.

Authors+Show Affiliations

Department of Surgery, University of Rome Tor Vergata, University of Parma.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

8884300

Citation

Tucci, G, et al. "Major Acute Inflammatory Complications of Diverticular Disease of the Colon: Planning of Surgical Management." Hepato-gastroenterology, vol. 43, no. 10, 1996, pp. 839-45.
Tucci G, Torquati A, Grande M, et al. Major acute inflammatory complications of diverticular disease of the colon: planning of surgical management. Hepatogastroenterology. 1996;43(10):839-45.
Tucci, G., Torquati, A., Grande, M., Stroppa, I., Sianesi, M., & Farinon, A. M. (1996). Major acute inflammatory complications of diverticular disease of the colon: planning of surgical management. Hepato-gastroenterology, 43(10), 839-45.
Tucci G, et al. Major Acute Inflammatory Complications of Diverticular Disease of the Colon: Planning of Surgical Management. Hepatogastroenterology. 1996 Jul-Aug;43(10):839-45. PubMed PMID: 8884300.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Major acute inflammatory complications of diverticular disease of the colon: planning of surgical management. AU - Tucci,G, AU - Torquati,A, AU - Grande,M, AU - Stroppa,I, AU - Sianesi,M, AU - Farinon,A M, PY - 1996/7/1/pubmed PY - 1996/7/1/medline PY - 1996/7/1/entrez SP - 839 EP - 45 JF - Hepato-gastroenterology JO - Hepatogastroenterology VL - 43 IS - 10 N2 - BACKGROUND/AIMS: The aim of this study was to determine the most appropriate surgical strategy in the management of patients with major inflammatory complications of colonic diverticular disease. MATERIALS AND METHODS: Out of 259 patients affected by complicated diverticular disease of the colon, 43 consecutive patients (16.6%) who underwent urgent or emergency surgical intervention for diverticular perforation during a 20-year period (1975-1994) were retrospectively analyzed. According to the changes in the surgical approach over the time, the series was divided into two groups: 1975-1985 group A (n = 23), 1986-1994 group B (n = 20). The clinical diagnosis was confirmed by operative and pathologic findings. RESULTS: Out of 43 patients, 11 underwent derivative procedure and 32 resection. There were no significant differences among the two groups of patients according to sex ratio and mean age. The overall percentage of patients in group B who underwent resective procedure (100%) was significantly greater in comparison with that in group A (52%) (p < 0.001). Colostomy and drainage was employed only during the first period (30%)(vs group B, p < 0.05) and the proportion of patients who underwent primary resection and anastomosis was significantly higher during the second period (45%) (vs group A, p < 0.05). CONCLUSIONS: It must be stressed that resection of the diseased segment at initial operation appears mandatory; one-stage procedure is indicated when infection is confined to the mesentery, while resection and anastomosis with covering colostomy (two-stage procedure) is preferable whenever peritoneal contamination has occurred. Hartmann's operation remains the procedure of choice in the patients presenting known impaired immunity or fecal contamination. SN - 0172-6390 UR - https://www.unboundmedicine.com/medline/citation/8884300/Major_acute_inflammatory_complications_of_diverticular_disease_of_the_colon:_planning_of_surgical_management_ L2 - http://www.diseaseinfosearch.org/result/2310 DB - PRIME DP - Unbound Medicine ER -