Acute perforation of sigmoid diverticula

Sakai, Leonard; Daake, J.W.; Kaminski, Donald L.

doi:10.1016/0002-9610(81)90318-4

Cited by 24 publications

(5 citation statements)

References 21 publications

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“…With this approach, the difficult detection of recurrent or persisting signs of peritonitis [22] leads to therapeutic delay, with multiple organ failure and a high associated mortality [1-3, 13, 23-26]. To improve outcome, we and others have advocated PR as the correct approach in patients with severe advanced peritonitis [18,24,27,28]. Our retrospective studies [24][25][26], as well as the results of this series and those of a nonrandomised prospective study [1] comparing PR with ODR, found a clinically and statistically significant survival benefit for the PR approach after univariate analysis.…”

Section: Discussionmentioning

confidence: 99%

Factors Affecting Mortality in Generalized Postoperative Peritonitis: Multivariate Analysis in 96 Patients

Mulier¹,

Penninckx²,

Verwaest³

et al. 2003

World j. surg.

175

110

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Mortality of generalized postoperative peritonitis remains high at 22% to 55%. The aim of the present study was to identify prognostic factors by means of univariate and multivariate analysis in a consecutive series of 96 patients. Mortality was 30%. Inability to clear the abdominal infection or to control the septic source, older age, and unconsciousness were significant factors related to mortality in the multivariate analysis. Failure to control the peritoneal infection (15%) was always fatal and correlated with failed septic source control, high Acute Physiology and Chronic Health Evaluation (APACHE) II score, and male gender. Failure to control the septic source (8%) also was always fatal and correlated with high APACHE II score and therapeutic delay. In patients with immediate source control, residual peritonitis occurred in 9% after purulent or biliary peritonitis and in 41% after fecal peritonitis ( p = 0.002). In patients without immediate control of the septic source, delayed control was still achieved in 100% after a planned relaparotomy (PR) strategy versus 43% after an on-demand relaparotomy (ODR) strategy ( p = 0.018). In the same patients, mortality was 0% in the PR group versus 64% in the ODR group ( p = 0.007). Early relaparotomy is related to improved septic source control. After relaparotomy for generalized postoperative peritonitis, a PR strategy is indicated whenever source control is uncertain. It also might decrease mortality in fecal peritonitis. An ODR approach is adequate for purulent and biliary peritonitis with safe septic source control.

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Section: Discussionmentioning

confidence: 99%

Factors Affecting Mortality in Generalized Postoperative Peritonitis: Multivariate Analysis in 96 Patients

Mulier¹,

Penninckx²,

Verwaest³

et al. 2003

World j. surg.

175

110

View full text Add to dashboard Cite

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“…Unfortunately, many studies failed to define precisely the preoperative status of their patients in concert with type and extent of peritonitis at time of urgent surgery [ 2–7]. This may account for the wide range of morbidity and mortality rates due to different surgical procedures applied.…”

Section: Discussionmentioning

confidence: 99%

“…Even today its surgical management is associated with a disappointingly high morbidity and mortality rate [ 1–4]. Although the incidence of perforated diverticulitis with concomitant diffuse peritonitis is still rare, there is some evidence that this complication will increase in the future as the elderly population is growing [ 5–7]. The degree of peritonitis and the time of its onset are probably the most important factors for the outcome in these patients [ 8–10].…”

Section: Introductionmentioning

confidence: 99%

Utility of appropriate peritonitis grading in the surgical management of perforated sigmoid diverticulitis

et al. 2000

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“…In the past, radiological workup often included plain abdominal and chest films to rule out obstruction or perforation. However, pneumoperitoneum has been reported to be uncommon and is not helpful in the accurate prediction of perforated diverticulitis because micro perforations are more common than macro perforations, and these are often sealed off by the surrounding mesentery and fat [23]. Prior to the advent of computed tomography (CT), the contrast enema examination was the primary diagnostic tool in the evaluation of colonic diverticular disease.…”

Section: Radiological Investigationsmentioning

confidence: 99%

Computed Tomography Evaluation of Diverticulitis

Lawrimore

Rhea

2004

J Intensive Care Med

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Acute diverticulitis is a frequent and important diagnosis in gastrointestinal disease, most commonly involving the colon. It is estimated that approximately 15% to 30% of patients with diverticulosis develop symptomatic diverticulitis at some point in the natural history of the condition, often requiring medical and/or surgical therapy. The clinical diagnosis is often difficult to make, and several radiological studies have been used over the past decades to assist in the diagnosis of acute diverticulitis. These include barium enema, ultrasound, and computed tomography (CT). A number of studies over the past decade have shown CT to be the preferable initial examination because of its ability to demonstrate not only the extent of intramural inflammation but also the degree of pericolic disease, including intraperitoneal inflammation, perforation, and abscess formation. Additional benefits of CT imaging include guiding therapeutic interventions in complicated forms of diverticular disease and providing an alternative diagnosis in patients without diverticulitis. The accuracy, techniques, criteria for diagnosis, and staging and applications of CT imaging in acute diverticulitis are discussed.

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Acute perforation of sigmoid diverticula

Cited by 24 publications

References 21 publications

Factors Affecting Mortality in Generalized Postoperative Peritonitis: Multivariate Analysis in 96 Patients

Factors Affecting Mortality in Generalized Postoperative Peritonitis: Multivariate Analysis in 96 Patients

Utility of appropriate peritonitis grading in the surgical management of perforated sigmoid diverticulitis

Computed Tomography Evaluation of Diverticulitis

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