Prognosefaktoren der perforierten Dickdarmdiverticulitis

Abstract

Morbidity and mortality after emergency procedures in 105 patients with perforated colonic diverticulitis were evaluated in a retrospective study. In different stages of diverticulitis (Hinchey classification: I, 8.6%; II, 14.3%; III, 57.1%; IV, 20.0%) mortality was 12.4%. Preoperative sepsis syndrome with leucopenia and disturbed liver function, cardiac risk factors and obesity were independent prognostic factors in multiple logistic regression. Accompanied by immunosuppression the mortality rate remarkably increased to 33%. The stage of peritonitis showed no influence on the prognosis. In multivariate analysis, surgical procedure (primary resection 12.4%. Hartmann's procedure 61.9%, non-resection procedures 25.7%) showed influence only on increased general complications.

Complicated Diverticulitis of the Sigmoid: A Prospective Study Concerning Primary Resection with Secure Primary Anastomosis

“…Those patients are rare and there is little experience with them. They show exceptions to the normal procedure because they are usually already in a serious situation and have to be treated individually with the main emphasis on the septic illness [1]. In those cases, we would not perform or recommend primary anastomosis in all cases, but would recommend Hartmann’s procedure instead.…”

“…It has a prevalence of about 40% in patients >60 years old [1]. Diverticulitis occurs in approximately 10–25% of all patients with diverticula at least once.…”

“…August and Wise [7]and Alanis et al [8]were able to show that a colostomy is not absolutely necessary even in cases of pericolonic abscess, localized pelvic abscess and mesenteric phlegmone, but usually is in generalized purulent or fecal peritonitis. In a review of the recent literature, most authors prefer primary anastomosis in patients without large abscess or advanced peritonitis [1, 2, 3, 10, 11, 12, 13, 14, 15], but classification and nomenclature are not used uniformly so that comparison of the results becomes difficult.…”

“…Treatment of complicated diverticulitis remains a challenge for the abdominal surgeon concerning the choice of single- or multiple-stage operations, because the severity of peritonitis is frequently difficult to assess and septic complications are the most important prognostic factor for patient outcome [1]. Especially in cases of acute complicated diverticulitis the surgeon has to decide whether to perform primary anastomosis or to choose the Hartmann procedure, which is believed to be safer [2], with all its disadvantages for the patient.…”

Colorectal Surgery and Anastomotic Leakage

“…Finally and most importantly, the MPI index [5]or Hinchey stage [6]have been found to be significant predictors of morbidity and mortality. The MPI index considers several patient-related factors and severity of disease, adding up to a score.…”