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[Deferred elective colonic resection in complicated acute diverticulitis].

Tullio Piardi1, Andrea Ferrari Bravo, Francesca Giampaoli

  • 1Dipartimento di Scienze Mediche e Chirurgiche Cattedra di Semeiotica Chirurgica, Università degli Studi, Spedali Civili, Brescia.

Chirurgia Italiana
|May 15, 2003
PubMed
Summary

Deferred elective surgery for acute diverticulitis with abscesses (Hinchey stage I-II) offers a definitive solution. This approach improves patient condition before operation, reducing mortality and morbidity compared to emergency surgery.

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Area of Science:

  • Gastroenterology
  • Surgical Oncology
  • Colorectal Surgery

Context:

  • Acute diverticulitis with pericolic or paracolic abscesses (Hinchey stage I-II) often requires intervention.
  • Initial medical management may not fully resolve underlying inflammation.
  • Recurrence rates suggest limitations of non-surgical or immediate surgical approaches.

Purpose:

  • To evaluate the efficacy of deferred elective resection for acute diverticulitis with abscesses.
  • To compare outcomes of deferred elective surgery versus emergency surgery.
  • To investigate the pathological findings post-deferred resection.

Summary:

  • Twenty-three patients with Hinchey stage I-II acute diverticulitis underwent deferred elective resection (descending colon and sigmoid with anastomosis) ~30 days post-acute episode.

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  • Pathological examination revealed persistent severe inflammation, explaining recurrence despite clinical improvement.
  • Deferred surgery allowed for optimal patient preparation (hydroelectrolytic balance, comorbidities, colon prep).

    • Impact:

    • Deferred elective surgery eliminates operative mortality and reduces postoperative morbidity compared to emergency operations.
    • This strategy provides definitive resolution of diverticulitis, preventing recurrences.
    • Overall hospital stay for deferred elective surgery is comparable to emergency procedures.