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Chirurgia 2005 October;18(5):313-8

Copyright © 2005 EDIZIONI MINERVA MEDICA

language: Italian

Acute complicated diverticulitis: comparison of different surgical treatment

Testi W., Ranalli M., Tumbiolo S., Staffieri C., De Martino A., Bing C., Genovese A., Tani F., Cirianni D., Consiglio F.


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Aim. Surgical treatment of acute complicated diverticulitis is still debate. The aim of this study is to compare the different surgical procedure in order to evaluate the better option for the surgeon.
Methods. From January 1998 to December 2003 we have seen 184 patients (100 male, 84 female, age's range 30-85 years) affected by acute complicated diverticulitis. In 90% of cases the disease affected only the sigmoid colon, in 3% the ascending colon and in 7% distal trasversus. All the patients underwent a preoperative screening (physical examination, blood test and TC scanning) to evaluate the operative risk. All the cases was classified according to Hinchey's classification.
Results. In patients with disease's stadium I or IIA of Hinchey's classification (86%) we have performed left hemicolectomy with primary anastomosis. When there was general peritonitis we have chosen Hartmann's procedure. All patients who underwent primary resection and anastomosis received an intraoperative colon lavage and in 5 cases we performed diverting colostomy. Mortality was 0.54% and percentage of dehiscence was 4.8%. In patients treated with Hartmann's procedure we have closed end-colostomy after 3 months.
Conclusion. Is our conviction that patients with localized peritonitis may undergo colon resection with primary anastomosis, joining diverting colostomy only when there is high suspicion of dehiscence. On the other hand, the presence of general, puruloid and/or fecal, peritonitis require, as better treatment, Hartmann's procedure.

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