[Surgical treatment of perforated diverticular sigmoiditis. A retrospective study apropos of 45 cases]

The authors report their experience with 45 cases of perforated diverticular sigmoiditis (10 cases of mesocolic abscesses, 13 cases of localised peritonitis and 22 cases of generalised peritonitis). The mean age of the patients was 69 years and a previous history of diverticulosis was found in 26.6% of patients. 18% were taking steroids or anti-inflammatories. The often atypical symptomatology only suggested sigmoid perforation in 50% of cases. Surgical procedures consisted of 33 immediate resections (group 1) and 12 conservative procedures (group 2). Overall mortality was 17.8%, and was 13% at the abscess and localised peritonitis stage, and 22.7% at the generalised peritonitis stage (difference not significant). 12% of patients died after resection in comparison with 33.3% after conservative surgery (difference not significant). Mortality was significantly higher when there was evidence of shock, pre-operative leucopenia and pyostercoral peritonitis. In group 1, the surgical morbidity was 24% with 9% reinterventions, while in group 2, there was a 50% complication rate and 25% reintervention rate. Intestinal continuity was reestablished in 67.5% of surviving patients with zero mortality. In view of the results obtained and after review of the literature, immediate resection would appear to give better results than conservative treatment.