Surgical management of complicated colonic diverticulitis

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

doi:10.1002/bjs.1800840334

Cited by 116 publications

(86 citation statements)

References 21 publications

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“…This procedureis usually performed on an emergent basis in patients with complicated diverticulitis, obstructing or perforated sigmoid carcinoma, or pene trating trauma [2,3]. When such patients un dergo sigmoid resection, a Hartmann's procedure is performed rather than primary reanastomosis of the bowel because of the risk of anastomotic rupture associated with inadequate bowel preparation, complicating peritonitis,or both.The creationof a tempo rary diverting colostomy allows peritoneal inflammationto subside;the colostomycan then be taken down and reanastomosed to the pouch during the second stage of the proce dure to restore colonic continuity.…”

mentioning

confidence: 99%

Hartmann's pouch: radiographic evaluation of postoperative findings.

Cherukuri¹,

Levine²,

Maki³

et al. 1998

American Journal of Roentgenology

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OBJECTIVE. The purposeof this studywas to determinethe usefulnessof contrast-en hanced radiography of the Hartmann's pouch for evaluating postoperative abnormalities.MATERIALS AND METHODS. We performed a retrospectivestudy of 84 patients with a Hartmann's pouch who underwent contrast-enhanced radiography of the pouch during a recent 7-year period. Sixty-four patients underwent single-contrast barium studies of the pouch, 17 underwent studies with a water-soluble contrast medium, and three underwent both types of studies. The radiographic studies were reviewed to determine the types and fre quencyof abnormalitiesinvolvingthe pouch.Medical recordswere also reviewedto deter mine clinical presentation andcourse.RESULTS. Abnormalitiesof the Hartmann'spouchwere detectedon contrast-enhanced radiography in 16 (19%) of the 84 patients. Of the 70 patients who underwent routine con trast-enhanced radiography of the pouch, 11 (16%) had abnormalities, including diversion colitis in three,leaks in two, adhesionsin two, recurrentcarcinomain two, ulcerativecolitis involving the pouch in one, and a stricture in one. In both patients with clinically silent leaks, the contrast-enhanced radiography was performed 3 months or more after creation of the pouch. Of the remaining 14 patients who underwent contrast-enhanced radiography because of suspectedcomplications involving the pouch, five (36%) had abnormalities revealed, in cluding leaks in two, fistulas in two, and recurrent carcinoma in one.CONCLUSION. Contrast-enhanced radiographyof the Hartmann'spouchrevealedab normalitiesof thepouchin 19% of patients,includingleaksor fistulas,diversioncolitis,adhe sions, strictures, and recurrent tumor. Because two patients had clinically silent leaks that were detected during the late postoperative period, it may be prudent to perform these studies with a water-soluble contrast medium to avoid the problems associated with extravasation of barium into the extra-or intraperitoneal spaces.T he Hartmann's procedure is a common surgical procedure in which a temporarydiverting co lostomy and blind-ending rectal or colonic stump closed by suture (Hartmann's pouch) are created after partial colectomy or sig moidectomy [1]. This procedureis usually performed on an emergent basis in patients with complicated diverticulitis, obstructing or perforated sigmoid carcinoma, or pene trating trauma [2,3]. When such patients un dergo sigmoid resection, a Hartmann's procedure is performed rather than primary reanastomosis of the bowel because of the risk of anastomotic rupture associated with inadequate bowel preparation, complicating peritonitis,or both.The creationof a tempo rary diverting colostomy allows peritoneal inflammationto subside;the colostomycan then be taken down and reanastomosed to the pouch during the second stage of the proce dure to restore colonic continuity.Leakage or even blowout ofthe blind-end ing rectal or colonic stump can occur as a po tentially life-threatening complication of the Hartmann's procedure [4â€"7]. Other compli cations inc...

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confidence: 99%

Hartmann's pouch: radiographic evaluation of postoperative findings.

Cherukuri¹,

Levine²,

Maki³

et al. 1998

American Journal of Roentgenology

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“…A pesar de los avances en el cuidado intensivo, imagenología y tratamiento médico, la mortalidad de esta condición se ha mantenido estable en el tiempo 17 . El tránsito intestinal puede ser reestablecido generalmente 3-6 meses después de la primera cirugía 18 , aunque se ha reportado que, en aproximadamente entre el 30% y 70% de los pacientes nunca se cierra la colostomía 15,[19][20][21] . Es más, se considera que la reconstitución tras una operación de Hartmann continúa siendo un procedimiento electivo difícil 22 , con morbilidad significativa 23 y que aun no cuenta con estudios clínicos aleatorizados que demuestren diferencias estadísticamente significativas entre el procedimiento laparoscópico y el convencional 24,25 .…”

Section: Alternativas De Manejo Quirúrgico Para La Diverticulitis Aguunclassified

Diverticulitis aguda complicada: tendencias en el tratamiento actual

Readi

et al. 2012

Rev Chil Cir

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Acute complicated diverticulitis. New trends in treatmentDiverticular disease refers to the presence of colon diverticula. Its prevalence increases with age and in a few cases present as diverticulitis. Acute complicated diverticulitis is potentially mortal, since it can perforate and require emergency surgery. the treatment of choice is the excision of the perforated segment and the creation of a proximal colostomy. there are other therapeutic alternatives such as excision with primary anastomosis and novel approaches such as laparoscopic peritoneal lavage. We herein review the new treatments of acute diverticulitis.Key words: Diverticular disease, diverticulitis, colectomy, laparoscopic lavage. ResumenLa enfermedad diverticular se refiere a la presencia de divertículos en el colon. Su prevalencia aumenta con la edad y sólo en pocos casos se presenta como diverticulitis aguda. La diverticulitis aguda complicada es una condición potencialmente mortal, por la posibilidad de una perforación libre que requiera cirugía de urgencia. El tratamiento de elección en la mayoría de los casos es la resección del segmento colónico que incluya la perforación y la creación de una colostomía proximal. Existen otros tratamientos en el manejo quirúrgico de la diverticulitis perforada, como la resección con anastomosis primaria y nuevas aproximaciones, como el lavado peritoneal por vía laparoscópica. Se revisa y discute en este artículo la tendencia actual en el manejo de la diverticulitis aguda perforada.Palabras clave: Enfermedad diverticular, diverticulitis aguda, colectomía, lavado peritoneal laparoscópico.

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“…Since a vesicosigmoidal fistula seldom closes spontaneously (1), a surgical procedure is generally necessary. Recently, most patients have been treated by resection and primary anastomosis without a protective colostomy (single-stage operation) (14). Resection and primary anastomosis with colostomy and/or the Hartmann procedure (two-stage operation) are performed for patients in poor condition.…”

Section: Sigmoid Colonmentioning

confidence: 99%

Vesico-ileosigmoidal Fistula Caused by Diverticulitis: Report of a Case and Literature Review in Japan

et al. 2003

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Enterovesical fistula is a relatively uncommon complication of colorectal and pelvic malignancies, diverticulitis, inflammatory bowel disease, radiotherapy, and trauma in Asian countries. A case of vesico-ileosigmoidal fistula and a literature review of this disease in Japan are presented. A 70-yr-old male was referred with complaints of urinary pain and pneumaturia. On admission, urinary tract infection and pneumaturia were presented. A barium enema demonstrated multiple diverticulum in his sigmoid colon and the passage of contrast medium into the bladder and ileum. Under the diagnosis of vesico-ileosigmoidal fistula due to suspected diverticulitis of the sigmoid colon, sigmoidectomy and partial resection of the ileum with partial cystectomy were performed. The histopathology revealed diverticulosis of the sigmoid colon with diverticulitis and development of a vesico-ileosigmoidal fistula. No malignant findings were observed. Until the year 2000, a total of 173 cases of vesico-sigmoidal fistula caused by diverticulitis had been reported in Japan. Pneumaturia and fecaluria are the most common types, presenting symptoms in 63% of the cases. Computed tomography, with a sensitivity of 40% to 100%, is the most commonly used diagnostic study. For patients with vesico-sigmoidal fistula, resection of the diseased sigmoid colon and partial cystectomy with primary anastomosis are the safest and most acceptable procedures, leading to the best results.

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Surgical management of complicated colonic diverticulitis

Abstract: The Hartmann operation may be the most popular at present, but resection with primary anastomosis is the safest procedure for all stages of complicated diverticulitis, and reduces costs. There is no longer any clinical indication for the three-stage operation.

Cited by 116 publications

References 21 publications

Hartmann's pouch: radiographic evaluation of postoperative findings.

Hartmann's pouch: radiographic evaluation of postoperative findings.

Diverticulitis aguda complicada: tendencias en el tratamiento actual

Vesico-ileosigmoidal Fistula Caused by Diverticulitis: Report of a Case and Literature Review in Japan

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