[Hartmann incontinuity resection in emergency treatment of perforated sigmoid diverticulitis]

Emergency operations were performed on 20 patients for perforated sigma diverticulitis with diffuse (n = 15) or locally delimited (n = 5) peritonitis, between 1979 and June 1986. The average age of the patients was 65.7 years. Sigma resection with closure of the rectosigmoid and colostomy, that is Hartmann's operation, was performed on all of them. The postoperative lethality was as high as 45 per cent (nine patients), but this was not attributable to complications for which the surgical method had to be blamed. Only one patient died of anastomosis dehiscence, following additional resection of part of the small intestine. All the other deaths (n = 8) had been caused by internal organic complications. Hence, lethality is believed to be controllable only by close cooperation from the very beginning between surgeon and specialist in intensive therapy. Re-anastomosis (generally three months from primary operation) can be simplified by means of mechanical staplers, with the risk being reduced to nearly nil. These are benefits that support the recommendation of Hartmann's operation as an emergency approach to perforated sigma diverticulitis. It can be performed even by the less experienced surgeon on night duty.