Perforated diverticulitis: a surgical dilemma

Thirty-eight patients, 18 males and 20 females (mean age 61 years) have been operated on for perforated diverticulitis, over the past 14 years. We assigned the patients into stage A (n = 12) when the inflammation was confined to the mesosigmoid folds, stage B (n = 16) when an intraabdominal abscess was walled off and stage C (n = 10) when a generalized peritonitis had developed. Resection of the perforated sigmoid was carried out in 24 patients either as Hartmann's procedure (n = 18) or with primary anastomosis (n = 6). The mortality rate in this setting was 0.0% and 16.6% respectively. In 14 patients, no resection was carried out in 24 patients either drainage and colostomy (n = 10) or only drainage (n = 4) with corresponding mortality rate 30% and 25%. Mortality rate in relation to the stage was: Stage A 16.16%, Stage B 12.5% and Stage C 10%. The higher mortality rate in stage A and B was due to the fact that less radical operations were carried out. Four of our five deaths in all stages occurred in patients in whom the perforated sigmoid was not resected. In conclusion resection of the perforated sigmoid with or without primary anastomosis regardless of the stage of the disease is recommended.