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Published on: December 18, 2010
Perforated Diverticulitis with Generalized Peritonitis: Low Stoma Rate Using a "Damage Control Strategy"
Maximilian Sohn1, I Iesalnieks2, A Agha2
1Klinik für Allgemein-, Viszeral-, Endokrine- und minimalinvasive Chirurgie, Klinikum Bogenhausen, Städtisches Klinikum München GmbH, Englschalkinger Strasse 77, 81925, Munich, Germany. maximilian.sohn@klinikum-muenchen.de.
World Journal of Surgery
|March 16, 2018
Summary
The Damage Control Strategy (DCS) for perforated diverticulitis with generalized peritonitis resulted in a 50% stoma rate at hospital discharge. DCS offers a low stoma rate for this severe condition.
Area of Science:
- Gastroenterology
- Surgical Procedures
- Colorectal Surgery
Background:
- Perforated diverticulitis of the sigmoid colon with generalized peritonitis (Hinchey III-IV) requires optimal surgical management.
- The efficacy of a Damage Control Strategy (DCS) for this condition is not well-defined.
Purpose of the Study:
- To evaluate the efficacy of a Damage Control Strategy (DCS) in managing perforated sigmoid colon diverticulitis with generalized peritonitis.
- To assess the outcomes, including stoma rates and mortality, associated with DCS.
Main Methods:
- A multicenter retrospective cohort study included 58 patients with perforated diverticulitis (Hinchey III-IV) treated with DCS.
- DCS involved a two-stage approach: limited resection with blind closure, followed by reconstruction 24-48 hours later.
- Reconstruction options included anastomosis with or without ileostomy, or Hartmann's procedure.
Main Results:
- Of 58 patients, 50% had a stoma at hospital discharge; 83% of survivors were stoma-free at follow-up.
- Postoperative mortality was 9% (5 patients), and median hospital stay was 18.5 days.
- Anastomosis was achieved in 83% of patients during the second procedure.
Conclusions:
- The Damage Control Strategy (DCS) is associated with a comparatively low stoma rate in patients with perforated diverticulitis and generalized peritonitis.
- DCS provides a viable surgical option for managing complex cases of perforated diverticulitis, balancing immediate management with staged reconstruction.
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