Surgical management of perforating diverticular disease in Austria

Perforated diverticulitis is a much feared complication of diverticular disease and requires immediate surgical therapy to limit the incipient peritonitis and its sequelae. The ensuing surgical approach which could best irradiate the septic focus as well as restore normal intestinal continuity with less morbidity and mortality has been a matter of controversy. In the last ten years primary resection and colostomy has replaced the three-stage procedure in most cases of peritonitis. Primary anastomosis, when peritoneal involvement is well confined, has been shown to give excellent results. To assess the surgical management of perforating diverticulitis in Austria, a questionnaire was sent to leading hospitals throughout the country and information of 241 patients with perforating diverticulitis was compiled. The overall peroperative mortality was 9%, and the highest rate of complication (37.9%) was observed after primary resection and anastomosis with temporary defunctioning proximal colostomy. The mortality, as expected, is directly proportional to the extent of peritonitis; it was significantly greater among patients with generalised peritonitis and lowest among cases of covered perforation.