One‐stage Sigmoid Colon Resection for Perforated Sigmoid Diverticulitis (Hinchey Stages III and IV)

Richter, Sven; Lindemann, W.; Kollmar, Otto; Pistorius, G.; Maurer, Christoph A.; Schilling, Martin K.

doi:10.1007/s00268-005-0439-5

Cited by 86 publications

(72 citation statements)

References 23 publications

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“…Outcome of purulent or fecal peritonitis was reported to depend mainly on preoperative fluid resuscitation and antimicrobial therapy, but not on primary repair [16, 17]. Although not proven in randomized controlled trials, it may seem that improvements in surgical and radiological intervention techniques, anesthesia and intensive care medicine could favor colonic resection with PA in emergency surgery for diverticular disease even if it is complicated by purulent or fecal peritonitis [5, 6, 8, 18]. …”

Section: Discussionmentioning

confidence: 99%

Outcome after Emergency Surgery for Acute Perforated Diverticulitis in 200 Cases

et al. 2007

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Background: Mortality and morbidity rates of acute perforated diverticulitis remain high. The ideal treatment is still controversial. The object of this study was to compare patients with perforated diverticulitis treated either by resection with primary anastomosis (PA) or Hartmann’s procedure (HP). Methods: A multicenter study was carried out on 200 consecutive patients with acute perforated diverticulitis who were presented in the surgical units of four affiliated teaching hospitals in Rotterdam, The Netherlands, between 1995 and 2005. Mortality and morbidity were compared in relation to type of surgery, ASA classification, age, gender, Mannheim Peritonitis Index (MPI), Hinchey score, surgeon’s experience, and the time of operation. Results: There was a tendency for more severely affected patients (Hinchey, MPI, ASA and age) to undergo HP. Multivariate logistic regression analysis showed no significant difference in mortality between HP and PA. After HP, more patients needed one or more reinterventions to treat postoperative complications compared to PA. Besides, HP resulted in a longer total hospital and intensive care unit stay. Specialist colorectal surgeons performed significantly more frequently a PA instead of a HP and had fewer postoperative complications than general surgeons. The time of operation did not influence the choice of surgical procedure. Conclusion: Selected patients with perforated diverticulitis can be managed well by PA, as it does not seem to be inferior to HP in terms of severe postoperative complications that need surgical or radiological reintervention and mortality. This decision should be made while taking into account the patient’s concomitant diseases, response on preoperative resuscitation and the availability of a surgeon experienced in colorectal surgery.

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Section: Discussionmentioning

confidence: 99%

Outcome after Emergency Surgery for Acute Perforated Diverticulitis in 200 Cases

et al. 2007

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“…[14] A randomized prospective study by Ravo et al [15,16] concluded that if feces could be excluded from intraluminal contact with the anastomotic site, an anastomosis can be performed safely even in the presence of peritonitis. Richter et al [17] reported a perforated sigmoid diverticulosis series with treatment by onestage sigmoid colon resection after peritoneal irrigation with saline in non-immunosuppressed patients. Nevertheless, many others have concluded that immunosuppression, septic shock, fecal peritonitis, or high cardiac risk patients at admission were correlated with higher morbidity and mortality rates, and that usage of a two-stage procedure with or without primary anastomosis would be safer than one-stage surgery.…”

Section: Discussionmentioning

confidence: 99%

Unexpected Colonic Perforation in a Renal Recipient. A Case Report

Serin¹,

Keskin²,

Bakkaloglu³

et al. 2013

Ulus Travma Acil Cerrahi Derg

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İmmünite baskılayıcı ilaçlara bağlı olarak gelişen gastrointestinal kanama ve perforasyon gibi komplikasyonlar sıklıkla solid organ nakli sonrası görülmektedir. Elli iki yaşında erkek hasta canlı vericiden böbrek naklinin 7. günün-de yara yerinden akıntı şikayeti ile başvurdu. Herhangi bir karın ağrısı yoktu. Üçlü immünsupresan kullanmakta idi. Karın grafisi ve ultrasonografisi normal saptandı ancak bilgisayarlı tomografide karın içerisinde yaygın serbest hava görüldü. Transplante böbrek fonksiyonları da dahil olmak üzere laboratuvar incelemesinde herhangi bir patolojik bulgu saptanmadı. Tanısal laparoskopi sonrası açığa dönüldü. Antimezenterik yüzde sigmoid kolon perforasyonu vardı. Divertikülit ve iskemi bulgusu yoktu, travmaya ait bulgu da görülmedi. Transrektal enstrümentasyon anamnezi de yoktu. Omentoplasti ve sigmoid loop kolostomi yapıl-dı. Ameliyatının dokuzuncu günüde hasta taburcu edildi. Ameliyatının birinci yılında da kolostomisi kapatıldı. Gastrointestinal komplikasyonlar ölümcül olabilir ancak uzun dönem sağkalımı ve gref fonksiyonunu etkilemedikleri bilinmektedir. Pekçoğu ameliyat sonrası erken dönem veya rejeksiyon atakları gibi yüksek doz immünite baskılayıcı ilaç kullanılan dönemde görülmektedir. Sağkalımda erken tanı ve tedavide agresif davranmak önemli rol oynar.Anahtar Sözcükler: Kolon perforasyonu; kolostomi; immünsup-resyon.Gastrointestinal complications such as gastrointestinal bleeding and perforation due to immunosuppressant use are seen more frequently after solid organ transplantation. A 52-year-old male was admitted on the 7th day of a living donor renal transplantation with serous drainage at the incision site. He had no abdominal complaints. He was on triple immunosuppressant therapy. Abdominal plain X-ray and ultrasonography were normal, but diffuse extraluminal air was detected on the computed tomography scan. There were no pathological laboratory findings regarding the function of the renal allograft. We began the operation laparoscopically and then converted to laparotomy. Sigmoid colonic perforation was detected on the antimesenteric side. Neither diverticulitis nor ischemia was observed, and no evidence of iatrogenic injury was seen. There was no transrectal instrumentation history. Omentoplasty and sigmoid loop colostomy were performed. He was discharged on the 9th day following the operation. His colostomy was closed one year after the operation. Gastrointestinal complications can be fatal, but do not seem to influence the long-term survival or renal allograft function. Most of them are seen after using high doses of immunosuppressants to manage the early postoperative period or episodes of acute rejection. Early diagnosis and aggressive treatment play an important role in survival.

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“…This is due to the growing body of literature supporting the high complication rate associated with Hartmann's procedure and eventual stoma reversal. Aside from the relatively high mortality associated with Hartmann's procedure, anastomotic leak rates post-reversal of up to 30 % and wound infection rates of 24 % have been reported [23,30,31]. Comparatively, findings from a systematic review of the literature found that primary resection and anastomosis are associated with mortality, which is nearly half of Hartman's procedure and a wound infection rate of 9 % and a leak rate of 14 % [23].…”

Section: Primary Resection and Anastomosismentioning

confidence: 99%

Surgical Management of Fulminant Diverticulitis

2013

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The optimal management of fulminant or complicated diverticulitis is the subject of debate in recent literature. The most common management strategy remains resection and end colostomy or Hartmann's procedure, first introduced in the 1940s, despite the introduction of more current approaches supported by decreased morbidity and mortality by various studies. The purpose of this paper is to provide a review of the strategies described for the management of fulminant diverticulitis and the most recent evidence available to support these approaches. We discuss the advantages and disadvantages of the Hartmann's procedure approach, as well as the most current management strategies, and offer both citation and review of relevant recent studies.

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One‐stage Sigmoid Colon Resection for Perforated Sigmoid Diverticulitis (Hinchey Stages III and IV)

Cited by 86 publications

References 23 publications

Outcome after Emergency Surgery for Acute Perforated Diverticulitis in 200 Cases

Outcome after Emergency Surgery for Acute Perforated Diverticulitis in 200 Cases

Unexpected Colonic Perforation in a Renal Recipient. A Case Report

Surgical Management of Fulminant Diverticulitis

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