Outcome of Diffuse Faecal and Purulent Peritonitis following Colonic Perforation

Abstract

The mortality from faecal or purulent peritonitis following colonic perforation has been reported to be between 15 and 40%. These reports extend over many years and cannot take into account the influence of modern intensive care or a standardized surgical approach. In the past 3 years 121 patients (75% over 60 years of age) presented to our institution with colonic perforation. Fifteen patients had a diffuse purulent peritonitis and a further 13 patients faecal peritonitis. The cause of perforation and peritonitis was in 17 cases diverticular disease, in 8 a carcinoma, in 2 colitis, and in 1 case an endoscopic perforation. Ninety-four percent of the patients with purulent peritonitis underwent a Hartmann procedure as the primary operation. In those patients with faecal peritonitis 60% underwent a Hartmann procedure and 34% a similar procedure modified by the site of perforation. The overall 30-day mortality was 7.5% (8/121); in the group with diffuse peritonitis it was 10.5%. Patients with diffuse peritonitis had a much higher risk of complications (60%) than patients with local peritonits (30%). We believe that the low mortality rate was due to improved intraoperative and postoperative management (fluid balance and routine antibiotic regime) following a standardized surgical approach. There was a significant morbidity in 60% of the patients.

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

“…1 Mortality is still high, up to 40% of cases, despite the progress in antibiotics regimens and fluid administration. 2 Hartmann procedure (HP) has long been considered to be a safe treatment for this severe clinical condition, accounting for about a half of all patients undergoing surgery for complicated AD in Europe, mostly as an open procedure; 3 however, more than 1/3 of the patients who undergo a HP do not have their stoma reversed within 1 year, 4 if ever 5 and when they have, they are exposed to the risk of a difficult surgical procedure due to the unrare sequela of the generalized peritonitis. Combined with improvements in medical support, this has led surgeons to consider whether resection with primary anastomosis (PA) or any other less-invasive surgical procedure could provide equivalent safety.…”