Damage control strategy for the treatment of perforated diverticulitis with generalized peritonitis

Sohn, Maximilian; Agha, Ayman; Heitland, W.; Gundling, Felix; Steiner, Phillip; Iesalnieks, Igors

doi:10.1007/s10151-016-1506-7

Cited by 46 publications

(47 citation statements)

References 21 publications

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“…With its mortality rate said to range from 11% to 33.3%, colon perforation requires intensive postoperative care. As a tertiary emergency medical institution, our hospital is equipped with an intensive care unit and can manage such treatments as artificial respiration, postoperative OAM, polymyxin B‐direct hemoperfusion, continuous hemodiafiltration, and others.…”

Section: Discussionmentioning

confidence: 99%

Study of the prognostic factor of the colon perforation case with the pan‐peritonitis that needed emergency surgery: a single‐center observational study

Nakamura

Yui

Muratsu

et al. 2019

Acute Medicine & Surgery

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Aim We divided patients treated with emergency surgery for pan‐peritonitis caused by colon perforation into the survival group and the death group based on outcome at postoperative day 30 and examined the prognostic factors for colon perforation. Methods The prognostic factors for colon perforation in 76 consecutive patients who underwent emergency surgery at Kansai Medical University Hospital (Hirakata, Japan) from April 2011 to March 2017 were investigated based on outcome at postoperative day 30. Results The average age of the 76 patients (41 men/35 women) was 73 years, and the causative disease of colon perforation was malignant/benign in 18/58 cases, with ileocecal perforation site in 8 cases, ascending colon in 6, transverse colon in 2, descending colon in 4, sigmoid colon in 49, and rectum in 7. All patients received laparotomy with irrigation drainage, and 9 patients (11.8%) were dead at 30 days. Upon comparing the 67 survivors with the 9 dead patients, we recognized a significant difference on preoperative spread of ascites on computed tomography (CT) (P = 0.002) in univariate analysis and on acute disseminated intravascular coagulation (DIC) score (odds ratio 2.289; 95% confidence interval, 1.188–4.410; P = 0.013) in multivariate analysis. Conclusion In our hospital, the preoperative acute DIC score was found to be a prognostic factor for colon perforation accompanied by pan‐peritonitis. Appropriate evaluation of the spread of ascites on the preoperative CT might also help predict patient prognosis.

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Section: Discussionmentioning

confidence: 99%

Study of the prognostic factor of the colon perforation case with the pan‐peritonitis that needed emergency surgery: a single‐center observational study

Nakamura

Yui

Muratsu

et al. 2019

Acute Medicine & Surgery

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“…Some patient series have investigated laparoscopic closure of a perforation combined with laparoscopic lavage but there is little evidence to support this practice [120]. There are some studies suggesting damage control with a second look within a couple of days [116,121]. Neither are established techniques.…”

Section: Should a High-fibre Diet Be Recommended Following An Episodementioning

confidence: 99%

European Society of Coloproctology: guidelines for the management of diverticular disease of the colon

Schultz

Azhar

Binda³

et al. 2020

Colorectal Disease

168

214

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Aim The goal of this European Society of Coloproctology (ESCP) guideline project is to give an overview of the existing evidence on the management of diverticular disease, primarily as a guidance to surgeons. Methods The guideline was developed during several working phases including three voting rounds and one consensus meeting. The two project leads (JKS and EA) appointed by the ESCP guideline committee together with one member of the guideline committee (WB) agreed on the methodology, decided on six themes for working groups (WGs) and drafted a list of research questions. Senior WG members, mostly colorectal surgeons within the ESCP, were invited based on publication records and geographical aspects. Other specialties were included in the WGs where relevant. In addition, one trainee or PhD fellow was invited in each WG. All six WGs revised the research questions if necessary, did a literature search, created evidence tables where feasible, and drafted supporting text to each research question and statement. The text and statement proposals from each WG were arranged as one document by the first and last authors before online voting by all authors in two rounds. For the second voting ESCP national representatives were also invited. More than 90% agreement was considered a consensus. The final phrasing of the statements with < 90% agreement was discussed in a consensus meeting at the ESCP annual meeting in Vienna in September 2019. Thereafter, the first and the last author drafted the final text of the guideline and circulated it for final approval and for a third and final online voting of rephrased statements. Results This guideline contains 38 evidence based consensus statements on the management of diverticular disease. Conclusion This international, multidisciplinary guideline provides an up to date summary of the current knowledge of the management of diverticular disease as a guidance for clinicians and patients.

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“…Although there was no difference in postoperative mortality, patients who underwent DCS followed by a second-look laparotomy with closure 24 hours to 48 hours later had a reduced stoma rate (83% vs 47%, p=0.038). 44 The exact parameters when to consider DCS for the emergency general surgery patient are not as well outlined as in the trauma setting. 45 46 A retrospective study of general surgery patients who underwent DCS found that indications should include severe sepsis/septic shock, elevated lactate >3, acidosis (pH<7.25), age >70 years, male gender, and multiple pre-existing comorbidities.…”

Section: Abdominal Compartment Syndromementioning

confidence: 99%

Open abdomen critical care management principles: resuscitation, fluid balance, nutrition, and ventilator management

Chabot

Nirula

2017

Trauma Surg Acute Care Open

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The term “open abdomen” refers to a surgically created defect in the abdominal wall that exposes abdominal viscera. Leaving an abdominal cavity temporarily open has been well described for several indications, including damage control surgery and abdominal compartment syndrome. Although beneficial in certain patients, the act of keeping an abdominal cavity open has physiologic repercussions that must be recognized and managed during postoperative care. This review article describes these issues and provides guidelines for the critical care physician managing a patient with an open abdomen.

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Damage control strategy for the treatment of perforated diverticulitis with generalized peritonitis

Abstract: Damage control strategy in patients with generalized peritonitis due to perforated diverticulitis leads to a significantly reduced stoma rate after the initial hospital stay without an increased risk of postoperative morbidity.

Cited by 46 publications

References 21 publications

Study of the prognostic factor of the colon perforation case with the pan‐peritonitis that needed emergency surgery: a single‐center observational study

Study of the prognostic factor of the colon perforation case with the pan‐peritonitis that needed emergency surgery: a single‐center observational study

European Society of Coloproctology: guidelines for the management of diverticular disease of the colon

Open abdomen critical care management principles: resuscitation, fluid balance, nutrition, and ventilator management

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