1989
DOI: 10.1007/bf02554554
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Emergency surgery for complicated diverticular disease

Abstract: Ninety-three patients who underwent surgery were studied retrospectively over a five-year period for complications of diverticular disease, including free perforation in 32 patients (with fecal peritonitis in 8), inflammation or peritonitis in 22 patients, an abscess in 11 patients, and intestinal obstruction in 14 patients. Sixty-eight patients (73 percent) had systemic symptoms and signs consistent with serious sepsis. There has been a growing popularity of the Hartmann procedure throughout the study period.… Show more

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Cited by 56 publications
(22 citation statements)
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“…Great variations in mortality have been reported, and this is due mainly to the inclusion criteria of different series. High mortality rates are usually reported in series with patients with perforated diverticulitis and poor premorbid conditions [11,17]. The high mortality in the present series was due to the patients' relatively advanced age and poor premorbid state.…”
Section: Discussionmentioning
confidence: 63%
“…Great variations in mortality have been reported, and this is due mainly to the inclusion criteria of different series. High mortality rates are usually reported in series with patients with perforated diverticulitis and poor premorbid conditions [11,17]. The high mortality in the present series was due to the patients' relatively advanced age and poor premorbid state.…”
Section: Discussionmentioning
confidence: 63%
“…The frequent complications encountered after these three-step operations [13][14][15], despite the introduc tion of antibiotherapy in 1939 [16], encouraged twostaged procedures, such as Hartmann's colectomy, which appeared to give better results, at least in severe diverticu litis with peritonitis [6, [17][18][19]. Mortality, however, still ranged from 8 [20] to 28% [19], and reestablishment of intestinal continuity was possible in only two thirds of the patients [19,20].…”
Section: Discussionmentioning
confidence: 99%
“…Several recent reports have attempted to identify cases fit for colon resection with immediate anastomosis, given to obvious advantages of this procedure in terms of mor bidity and mortality, shorter hospitalization and avoid ance of the need for colostomy [3,4,13,24], This proce dure is undoubtedly an excellent option for Hinchey's stages 1 and 2, with mortality not exceeding 3.4% [4,19,20,22], but it should be preceded, whenever possible, by mechanical bowel preparation, reported in 88 [22] to 100% [4] of cases. Most authors, however, still feel reluc tant to advocate immediate anastomosis in diverticulitis with generalized peritonitis (Hinchey's stages 3 and 4), despite two short optimistic series claiming no death: Alanis et al [24] performed 3 one-stage procedures in a group of 11 patients graded stage 3, whereas Medina et al [2] performed three similar procedures in a group of 6 patients graded stage 4.…”
Section: Discussionmentioning
confidence: 99%
“…The lack of muscular layer in diverticula and the concomitant alteration in structural protein synthesis by corticosteroids would favor diverticular perforation [7]. Hartmann’s procedure for patients on steroid therapy with perforation of colonic diverticula has been reported with a mortality rate up to 50% [13]. In the current series, overall mortality rate for patients with perforation of the sigmoid was 31%, and 25% after Hartmann’s procedure.…”
Section: Discussionmentioning
confidence: 76%