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Acute perforated diverticulitis: primary resection and anastomosis?
V A Medina1, G K Papanicolaou, R R Tadros
1St. Vincent Medical Center, Toledo, Ohio.
Connecticut Medicine
|May 1, 1991
Summary
For acute perforated diverticulitis with fecal peritonitis, primary resection and anastomosis is a viable surgical option. This approach may be safe and effective in selected patients, challenging previous contraindications.
Area of Science:
- Gastroenterology
- Colorectal Surgery
- Surgical Innovation
Background:
- Surgical management of acute colonic diverticulitis is shifting towards single-stage procedures.
- The Hinchey classification system categorizes acute perforated diverticulitis into Stages I-IV.
Purpose of the Study:
- To evaluate the safety and efficacy of primary resection and anastomosis in patients with Stage IV acute perforated diverticulitis (fecal peritonitis).
- To determine if fecal peritonitis remains an absolute contraindication for immediate bowel reconstruction.
Main Methods:
- Retrospective review of 146 patients with acute perforated diverticulitis (1983-1988).
- Focus on six patients with Stage IV disease, comparing primary resection/anastomosis with Hartmann procedure.
- Analysis of length of stay and mortality rates.
Main Results:
- Patients undergoing primary resection and anastomosis had a mean length of stay of 18.7 days with zero mortality.
- Patients undergoing Hartmann procedure had a mean length of stay of 12.7 days with one mortality.
- Primary resection and anastomosis demonstrated comparable outcomes in selected Stage IV cases.
Conclusions:
- Primary resection with anastomosis is a potential alternative for selected patients with fecal peritonitis (Stage IV perforated diverticulitis).
- Fecal peritonitis should not be considered an absolute contraindication for immediate bowel reconstruction.
- Patient selection criteria include absence of concomitant disease, adequate resuscitation, surgical expertise, and meticulous postoperative care.