Acute perforative diverticulitis of the colon as a rare cause for the development of abdominal compartment syndrome

Deenichin, G; Dimov, Rosen; Molov, V.; Stefanov, Ch.

doi:10.14748/ssm.v40i1.552

Cited by 3 publications

(12 citation statements)

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“…A detailed description of the characteristics of patients included in the 10 selected studies is presented in Table 1 . 15 – 24 …”

Section: Resultsmentioning

confidence: 99%

“…The first, that is, conventional, 15 , 16 , 18 , 20 , 21 , 24 is characterized by the shortest possible initial emergency operation focused on source control (limited resection of the diseased colonic segment) leaving the stapled remaining colon with or without a stoma or reconstruction in situ. In selected cases, instead of colonic resection, closure of the perforation site with interrupted sutures, adequate lavage, and temporary closure was performed.…”

Section: Resultsmentioning

confidence: 99%

“…The second consists laparoscopic abdominal washing and drainage only, without resection. 19 , 24 The proponents of washing and drainage 19 , 24 considered these procedures as definitive surgery and reintervention was performed only in case of postoperative complications. 19 Moore et al 20 did not consider this technique as DCS and reserved it only for patients with Hinchey III without septic shock.…”

Section: Resultsmentioning

confidence: 99%

“…Conventional DCS 15 , 16 , 18 , 20 , 21 , 24 was performed in patients with septic shock defined as hemodynamically unstable patients who required immediate inotropic or vasopressor support 15 , 16 , 20 , 21 and generalized purulent or fecal peritonitis; on the contrary, patients who underwent laparoscopic DCS had only generalized purulent or fecal peritonitis and were not hemodynamically unstable. 19 , 22 Kown et al 16 recommended the HP in unstable but controllable patients, while DCS should be limited to extremely unstable patients.…”

Section: Resultsmentioning

confidence: 99%

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Role of Damage Control Surgery in the Treatment of Hinchey III and IV Sigmoid Diverticulitis

et al. 2014

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Many of the treatment strategies for sigmoid diverticulitis are actually focusing on nonoperative and minimally invasive approaches. The aim of this systematic review was to evaluate the actual role of damage control surgery (DCS) in the treatment of generalized peritonitis caused by perforated sigmoid diverticulitis.A literature search was performed in PubMed and Google Scholar for articles published from 1960 to July 2013. Comparative and noncomparative studies that included patients who underwent DCS for complicated diverticulitis were considered.Acute Physiology and Chronic Health Evaluation score, duration of open abdomen, intensive care unit length of stay, reoperation, bowel resection performed at first operation, fecal diversion, method, and timing of closure of abdominal wall were the main outcomes of interest.According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses algorithm for the literature search and review, 10 studies were included in this systematic review. DCS was exclusively performed in diverticulitis patients with septic shock or requiring vasopressors intraoperatively. Two surgical different approaches were highlighted: limited resection of the diseased colonic segment with or without stoma or reconstruction in situ, and laparoscopic washing and drainage without colonic resection.Despite the heterogeneity of patient groups, clinical settings, and interventions included in this review, DCS appears to be a promising strategy for the treatment of Hinchey III and IV diverticulitis, complicated by septic shock. A tailored approach to each patient seems to be appropriate.

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“…A detailed description of the characteristics of patients included in the 10 selected studies is presented in Table 1 . 15 – 24 …”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 2 more Smart Citations

Role of Damage Control Surgery in the Treatment of Hinchey III and IV Sigmoid Diverticulitis

et al. 2014

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“…Perforation peritonitis accounts for almost all cases of peritonitis, but the source of peritoneal contamination varies considerably from region to region, with the infective causes (including tuberculosis) still common in the tropics and developing countries, where younger people below age 40 years are mainly affected 1,2 . Inflammatory causes from the large bowel, gastroduodenal perforations from peptic ulcer and malignant perforations of the colon account for most of the cases from developed countries 3,4 . Complications of acute appendicitis (perforation, peritonitis and abscess) are common to all regions, whereas perforated gallbladder is uncommon in most parts of the tropics 5 .…”

Section: Introductionmentioning

confidence: 99%

Causes and treatment outcome of perforation peritonitis in north eastern Nigeria

Ali¹,

Gali

2010

Surgical Practice

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Background:Intestinal perforations cause generalized peritonitis and overwhelming sepsis resulting in high morbidity and mortality. The purpose of the present study was to review the causes and treatment outcome of non-traumatic perforation peritonitis in a government referral hospital in north-eastern Nigeria. Patients and Methods: In a retrospective study, the clinical records of 153 patients with intraoperative diagnosis of non-traumatic perforation associated peritonitis managed in the Federal Medical Centre, Azare, Nigeria between June 2004 and May 2009 were reviewed. Results: One hundred and fifty-three patients, comprising 112 males (73.2%) and 41 females were operated for perforation peritonitis, including 31 (20.3%) children. The mean age was 21.88 years Ϯ 14.51 (range 4-70). The mean time lapse between onset of symptoms and presentation to hospital was 5.4 Ϯ 3.7 days (range 0.75-21). Forty-eight (31.4%) of the patients were operated within 24 h of presentation and 105 (68.3%) after 24 h. The main symptoms were abdominal pain in 150 (98.9%), fever in 108 (70.6%), and abdominal distention in 108 (70.6%). The main causes of perforation peritonitis were typhoid ileal perforation in 98 (64.0%), perforated peptic ulcer in 25 (16.3%) and perforated appendix in 22. Tuberculous ileal perforation was seen in one (0.6%) patient. Wound infection 39 (25.5%) and wound dehiscence 15 (9.8%), were the most common postoperative complications. Enterocutaneous fistula was seen in 21 (13.7%) of the patients and was associated with mortality in nine (42.8%) patients. The overall mortality rate was 26.1%, mainly from overwhelming sepsis and severe electrolyte derangement. Conclusion: The outcome of perforation peritonitis depended on the underlying cause, the duration of symptoms before treatment, and the general health of the patient. Typhoid ileal perforation is the most common cause of perforation peritonitis in our environment.

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The role of damage control surgery in the treatment of perforated colonic diverticulitis: a systematic review and meta-analysis

Cirocchi

Popivanov

Konaktchieva

et al. 2020

Int J Colorectal Dis

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Introduction Damage control surgery (DCS) is the classic approach to manage severe trauma and has recently also been considered an appropriate approach to the treatment of critically ill patients with severe intra-abdominal sepsis. The purpose of the present review is to evaluate the outcomes following DCS for Hinchey II–IV complicated acute diverticulitis (CAD). Methods A comprehensive systematic search was undertaken to identify all randomized clinical trials (RCTs) and observational studies, irrespectively of their size, publication status, and language. Adults who have undergone DCS for CAD Hinchey II, III, or IV were included in this review. DCS is compared with the immediate and definitive surgical treatment in the form of HP, colonic resection, and primary anastomosis (RPA) with or without covering stoma or laparoscopic lavage. We searched the following electronic databases: PubMed MEDLINE, Scopus, and ISI Web of Knowledge. The protocol of this systematic review and meta-analysis was published on Prospero (CRD42020144953). Results Nine studies with 318 patients, undergoing DCS, were included. The presence of septic shock at the presentation in the emergency department was heterogeneous, and the weighted mean rate of septic shock across the studies was shown to be 35.1% [95% CI 8.4 to 78.6%]. The majority of the patients had Hinchey III (68.3%) disease. The remainder had either Hinchey IV (28.9%) or Hinchey II (2.8%). Phase I is similarly described in most of the studies as lavage, limited resection with closed blind colonic ends. In a few studies, resection and anastomosis (9.1%) or suture of the perforation site (0.9%) were performed in phase I of DCS. In those patients who underwent DCS, the most common method of temporary abdominal closure (TAC) was the negative pressure wound therapy (NPWT) (97.8%). The RPA was performed in 62.1% [95% CI 40.8 to 83.3%] and the 22.7% [95% CI 15.1 to 30.3%]: 12.8% during phase I and 87.2% during phase III. A covering ileostomy was performed in 6.9% [95% CI 1.5 to 12.2%]. In patients with RPA, the overall leak was 7.3% [95% CI 4.3 to 10.4%] and the major anastomotic leaks were 4.7% [95% CI 2.0 to 7.4%]; the rate of postoperative mortality was estimated to be 9.2% [95% CI 6.0 to 12.4%]. Conclusions The present meta-analysis revealed an approximately 62.1% weighted rate of achieving GI continuity with the DCS approach to generalized peritonitis in Hinchey III and IV with major leaks of 4.7% and overall mortality of 9.2%. Despite the promising results, we are aware of the limitations related to the significant heterogeneity of inclusion criteria. Importantly, the low rate of reported septic shock may point toward selection bias. Further studies are needed to evaluate the clinical advantages and cost-effectiveness of the DCS approach.

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Acute perforative diverticulitis of the colon as a rare cause for the development of abdominal compartment syndrome

Cited by 3 publications

References 0 publications

Role of Damage Control Surgery in the Treatment of Hinchey III and IV Sigmoid Diverticulitis

Role of Damage Control Surgery in the Treatment of Hinchey III and IV Sigmoid Diverticulitis

Causes and treatment outcome of perforation peritonitis in north eastern Nigeria

The role of damage control surgery in the treatment of perforated colonic diverticulitis: a systematic review and meta-analysis

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