Surgical management of complicated colonic diverticulitis

Wedell, J; Banzhaf, G; Chaoui, R.; Fischer, R.; Reichmann, J

doi:10.1046/j.1365-2168.1997.02566.x

Cited by 64 publications

(31 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Infective complications caused 6 of our deaths, and another 6 deaths were related to persistent sepsis. This may be a consequence of incomplete resection of the involved sigmoid mesocolon and a failure to perform staged peritoneal lavage with planned relaparotomy in septic pelvic peritonitis, as is recommended [15]. Pelvic sepsis caused by fecal peritonitis may be poorly tolerated by the elderly [16], but age was not a predictor of postoperative complications or mortality here.…”

Section: Discussionmentioning

confidence: 91%

Prognostic Factors of Perforated Sigmoid Diverticulitis in the Elderly

2005

View full text Add to dashboard Cite

Background: The Finnish population is aging fast and the prevalence of perforated sigmoid diverticulitis is simultaneously increasing in northern Finland. The fact that an increasing number of elderly patients, with their age-specific problems, are subjected to emergency surgery for acute diverticulitis underlines the importance of risk stratification.Methods: One hundred and seventy-two patients admitted to Oulu University Hospital because of diverticular perforation from 1983 to 2002 were identified from the computer database. The clinical variables were evaluated as prognostic indicators of postoperative complications, mortality and time of hospitalization. Results: The resection rate was 91%; 64 primary anastomoses, 93 Hartmann’s procedures and two covering colostomies were performed. The overall complication rate was 33%. In patients under 70 years, a stepwise logistic regression analysis showed that the Mannheim Peritonitis Index (MPI) score and American Society of Anesthesiologists (ASA) score were independent prognostic factors. None of factors predicted morbidity in patients over 70 years. Overall mortality rate was 8%, without any significant difference between the procedures. Of the clinical variables, MPI score, ASA score, Hinchey classes and malnutrition correlated with mortality. All patients who died presented with ASA scores of III–IV, and 12 out of 14 patients had an MPI score of II. In a stepwise logistic regression analysis, only the MPI score seemed to be an independent predictor of mortality. Conclusions: Mortality is related to age but age alone is not an independent predictor of mortality. The MPI score is useful in predicting the risk of death in patients with perforated diverticulitis.

show abstract

Section: Discussionmentioning

confidence: 91%

Prognostic Factors of Perforated Sigmoid Diverticulitis in the Elderly

2005

View full text Add to dashboard Cite

show abstract

“…A growing number of publications, however, allege that an anastomosis may be safely attempted in selected patients suffering from localized peritonitis or suppuration – as opposed to those with diffuse forms of established peritonitis [3, 4, 22]. Are American gastrointestinal surgeons influenced by such trend and data?…”

Section: Discussionmentioning

confidence: 99%

“…The traditionally alleged issue of the unprepared colon is addressed by some surgeons using intra-operative, antegrade colonic lavage – introduced by Dudley in 1980 [10, 11]. Others do not bother with the time consuming and potentially messy intra-operative bowel lavage at all [3, 4]. Moreover, the need to mechanically prepare the colon prior to an anastomosis is based more on dogma than on clear scientific evidence [12].…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Current Practices in Left-Sided Colonic Emergencies

Goyal

Schein

2001

Dig Surg

View full text Add to dashboard Cite

Background: The paradigms in the surgical management of obstruction and perforation of the left colon – once considered absolute contraindications to primary resection and anastomosis – are changing. The aim of this survey was to poll American Gastrointestinal surgeons on their current approach to left colonic emergencies. Methods: A questionnaire was sent to 500 US-based surgeons, randomly selected members from the membership list of the Society for Surgery of the Alimentary Tract. It surveyed the surgeons on how they would approach ‘good-risk’ and ‘poor-risk’ patients with left colonic obstruction or perforation. Results: 215 (43%) surgeons responded to the questionnaire; 180 fully completed questionnaires (36%) were analyzed. Sigmoid obstruction: 96 responders (53%) selected a one-stage procedure in ‘good-risk’ patients; 78 preferred sigmoid resection with (n = 46) or without (n = 32) ‘on-table’ colonic lavage and 18 opted for a subtotal colectomy and ileo-rectal anastomosis. Most (94%) responders preferred a staged procedure in ‘high-risk’ patients: a Hartmann resection (n = 120) or a transverse colostomy (n = 46). Sigmoid diverticular perforation: only one third of the responders recommended a one-stage procedure in ‘good-risk’ patients: 58 would perform a sigmoidectomy with (n = 19) or without (n = 39) ‘on-table’ colonic lavage; only two opted for subtotal colectomy with ileo-rectal anastomosis. In ‘high-risk’ patients most surgeons opted for a Hartmann’s (88%) procedure or a diverting colostomy (7%). Conclusions: This survey suggests that a half and one-third of the responders would perform a one-stage resection and anastomosis in ‘good-risk’ patients with left colonic obstruction and perforation, respectively. In ‘poor-risk’ patients most responders would still opt for a staged procedure.

show abstract

“…However, in the modern literature a trend can be observed towards more definitive surgery. Resection and primary anastomosis has been claimed to be feasible even if complicated [7, 8, 9]. Thirty to 20 years ago, primary resection was dissuaded under such circumstances.…”

Section: Risk Factors For Septic Complicationsmentioning

confidence: 99%