Acute Perforated Diverticulitis of the Sigmoid Colon with Generalized Peritonitis

Belding, Hiram H.

doi:10.1001/archsurg.1957.01280100029004

Cited by 39 publications

(5 citation statements)

References 3 publications

(1 reference statement)

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“…Also during this period PRA with or without proximal protective colostomy was increasingly reported [32–35]. The results were good in the presence of a minimum peri-diverticular contamination or intra-mesenteric abscess [34]. …”

Section: Resultsmentioning

confidence: 99%

A historical review of surgery for peritonitis secondary to acute colonic diverticulitis: from Lockhart-Mummery to evidence-based medicine

Cirocchi

Afshar

Saverio³

et al. 2017

World J Emerg Surg

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The management of patients with colonic diverticular perforation is still evolving. Initial lavage with or without simple suture and drainage was suggested in the late 19th century, replaced progressively by the three-stage Mayo Clinic or the two-stage Mickulicz procedures. Fears of inadequate source control prompted the implementation of the resection of the affected segment of colon with formation of a colostomy (Hartman procedure) in the 1970’s. Ensuing development of the treatment strategies was driven by the recognition of the high morbidity and mortality and low reversal rates associated with the Hartman procedure. This led to the wider use of resection and primary anastomosis during the 1990’s.The technique of lavage and drainage regained popularity during the 1990’s. This procedure can also be performed laparoscopically with the advantage of faster recovery and shorter hospital stay. This strategy allows resectional surgery to be postponed or avoided altogether in many patients; and higher rates of primary resection and anastomosis can be achieved avoiding the need for a stoma. The three recent randomized controlled trials comparing laparoscopic peritoneal lavage alone to resectional surgery reported inconsistent outcomes.The aim of this review is to review the historical evolution and future reflections of surgical treatment modalities for diffuse purulent and feculent peritonitis. In this review we classified the various surgical strategies according to Krukowski et al. and Vermeulen et al. and reviewed the literature related to surgical treatment separately for each period.

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Section: Resultsmentioning

confidence: 99%

A historical review of surgery for peritonitis secondary to acute colonic diverticulitis: from Lockhart-Mummery to evidence-based medicine

Cirocchi

Afshar

Saverio³

et al. 2017

World J Emerg Surg

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“…Belding first described resection and primary anastomosis in perforated diverticulitis with peritonitis in 1957 5 ; he described 3 cases with no anastomotic leaks. Benefits of primary anastomosis for the patient include avoidance of a stoma and its inherent morbidity.…”

Section: Background On Diverticulitis and Its Managementmentioning

confidence: 99%

Perforated diverticulitis: To anastomose or not to anastomose? A systematic review and meta-analysis

Shaban

Carney

McGarry

et al. 2018

International Journal of Surgery

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“…This was associated with an unacceptably high morbidity and mortality 16,17 attributed to the diseased segment of colon, which was left in situ. In an effort to improve the outcome, a 2-stage approach involving resection of the diseased colon at the initial surgery was recommended, [18][19][20] which has become the current practice at most centers. Our own institution's experience with the management of this disease, as reported in 1985, also supported and recommended the 2-stage approach.…”

Section: Iverticulosis Of the Co-mentioning

confidence: 99%

Impact of Primary Resection on the Outcome of Patients With Perforated Diverticulitis

2004

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Background: Primary resection has replaced the conventional drainage procedure in the management of patients with generalized peritonitis complicating diverticular disease of the colon. This study investigates the impact of primary resection on operative mortality, identifies predictors of mortality, and compares the results with those of our earlier experience. Hypothesis: Primary resection of the perforated diseased segment of the colon is associated with lower mortality rates than the drainage procedure in patients with Hinchey stages 3 and 4 diverticulitis. Design: Retrospective analysis. Setting: Tertiary care referral center. Patients: We included 138 consecutive patients who underwent emergent operation for generalized peritonitis complicating diverticular disease of the colon (Hinchey stages 3 and 4) during a period of 16 years (January 1983 to May 1999). Main Outcome Measures: The 30-day mortality rate was analyzed and predictors of mortality identified. Results: Patients were classified as having spreading purulent peritonitis (n=44, 31.9%), diffuse peritonitis (n=64, 46.4%), or fecal peritonitis (n=30, 21.7%). One hundred thirty-one patients (94.9%) underwent primary resection, 6 patients (4.3%) underwent resection and primary anastomosis, and 1 patient required total colectomy and end ileostomy. Thirteen of the 138 patients in the present group died (1983-1998), representing a perioperative mortality rate of 9%. There was no significant difference in mortality when compared with our earlier study (1972-1982), which had a mortality rate of 12%, considering that more than 25% of the patients in that group were managed by colostomy and drainage alone. Factors identified univariately as predictors of mortality were age of more than 70 years (P=.047), 2 or more comorbid conditions (PϽ.01), obstipation at initial examination (P=.02), use of steroids (P=.01), and perioperative sepsis (PϽ.001). Conclusions: Primary resection has become the standard practice for patients with generalized peritonitis complicating diverticulitis. Mortality rates have not significantly declined despite more aggressive surgical management of the septic source. Because advanced age, comorbid conditions, and perioperative sepsis predict mortality, it is suggested that further reduction in mortality will require improvement in medical management of perioperative sepsis and comorbid conditions.

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Acute Perforated Diverticulitis of the Sigmoid Colon with Generalized Peritonitis

Cited by 39 publications

References 3 publications

A historical review of surgery for peritonitis secondary to acute colonic diverticulitis: from Lockhart-Mummery to evidence-based medicine

A historical review of surgery for peritonitis secondary to acute colonic diverticulitis: from Lockhart-Mummery to evidence-based medicine

Perforated diverticulitis: To anastomose or not to anastomose? A systematic review and meta-analysis

Impact of Primary Resection on the Outcome of Patients With Perforated Diverticulitis

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