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[Diverticular disease and its treatment].
Minerva Chir 1997; 52(3):261-70MC

Abstract

Diverticular disease of the colon is being seen with increasing frequency. Not infrequently, the first attack of diverticulitis may result in serious and potentially fatal complications. A period of observation and conservative management is necessary to determine the outcome of a particular attack. Approximately 30% of symptomatic patients require surgical intervention. Controversy still surrounds the appropriate operative approach to be employed in the management of diverticular disease, moreover when it presents with a complication. In general, resection is the procedure of choice for perforating diverticulitis. There is an emerging role for down-staging interventions in the recent literature; with few exception, there is no role for three-stages procedure for diverticular disease. In the setting of stage I or stage II disease (Hinchey classification) primary resection with anastomosis is safe and should be performed. Proximal colostomy formation may be carried out at the discretion of the surgeon if warranted by such local circumstances as contiguous inflammation or macroscopic contamination. For patients with stage III and stage IV disease endcolostomy with Hartmann closure of the rectum is the procedure of choice, although anastomosis with proximal stoma may prove to be an acceptable alternative. We reviewed the changing patterns in the operative treatment in 46 patients admitted to our Division for perforated diverticulitis. We performed the resection with anastomosis in 39 patients with perforation at the II stage; in 7 patients with generalized peritonitis (stage III-IV by Hinchey) we preferred Hartmann intervention in 4 cases and the three-stages procedure in 3 cases. We had no death at all. From 1979 to 1994 we noticed an increasing use of down-staging procedures.

Authors+Show Affiliations

Divisione di Chirurgia Generale A, Azienda Ospedaliera, San Giovanni Battista.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
English Abstract
Journal Article
Review

Language

ita

PubMed ID

9148215

Citation

Formento, E, et al. "[Diverticular Disease and Its Treatment]." Minerva Chirurgica, vol. 52, no. 3, 1997, pp. 261-70.
Formento E, Guglielminotti P, Reggio D, et al. [Diverticular disease and its treatment]. Minerva Chir. 1997;52(3):261-70.
Formento, E., Guglielminotti, P., Reggio, D., Saracco, M., & Patelli, E. (1997). [Diverticular disease and its treatment]. Minerva Chirurgica, 52(3), pp. 261-70.
Formento E, et al. [Diverticular Disease and Its Treatment]. Minerva Chir. 1997;52(3):261-70. PubMed PMID: 9148215.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - [Diverticular disease and its treatment]. AU - Formento,E, AU - Guglielminotti,P, AU - Reggio,D, AU - Saracco,M, AU - Patelli,E, PY - 1997/3/1/pubmed PY - 1997/3/1/medline PY - 1997/3/1/entrez SP - 261 EP - 70 JF - Minerva chirurgica JO - Minerva Chir VL - 52 IS - 3 N2 - Diverticular disease of the colon is being seen with increasing frequency. Not infrequently, the first attack of diverticulitis may result in serious and potentially fatal complications. A period of observation and conservative management is necessary to determine the outcome of a particular attack. Approximately 30% of symptomatic patients require surgical intervention. Controversy still surrounds the appropriate operative approach to be employed in the management of diverticular disease, moreover when it presents with a complication. In general, resection is the procedure of choice for perforating diverticulitis. There is an emerging role for down-staging interventions in the recent literature; with few exception, there is no role for three-stages procedure for diverticular disease. In the setting of stage I or stage II disease (Hinchey classification) primary resection with anastomosis is safe and should be performed. Proximal colostomy formation may be carried out at the discretion of the surgeon if warranted by such local circumstances as contiguous inflammation or macroscopic contamination. For patients with stage III and stage IV disease endcolostomy with Hartmann closure of the rectum is the procedure of choice, although anastomosis with proximal stoma may prove to be an acceptable alternative. We reviewed the changing patterns in the operative treatment in 46 patients admitted to our Division for perforated diverticulitis. We performed the resection with anastomosis in 39 patients with perforation at the II stage; in 7 patients with generalized peritonitis (stage III-IV by Hinchey) we preferred Hartmann intervention in 4 cases and the three-stages procedure in 3 cases. We had no death at all. From 1979 to 1994 we noticed an increasing use of down-staging procedures. SN - 0026-4733 UR - https://www.unboundmedicine.com/medline/citation/9148215/[Diverticular_disease_and_its_treatment]_ L2 - http://www.diseaseinfosearch.org/result/2310 DB - PRIME DP - Unbound Medicine ER -