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[Emergency interventions in complicated colonic diverticulosis]
H Wehrli1, T Sulser, A Akovbiantz
1Chirurgischen Klinik, Stadtspitals Waid Zürich.
Zentralblatt Fur Chirurgie
|January 1, 1987
Summary
This study of 480 patients with colonic diverticulosis found that emergency surgery for diverticulitis had a higher mortality rate (22.6%) than planned operations (4.4%). Drainage procedures also showed increased mortality compared to resection.
Area of Science:
- Gastroenterology
- Surgical Gastroenterology
- Clinical Medicine
Context:
- This paper reviews 480 patients hospitalized for colonic diverticulosis or diverticulitis between 1970 and 1986.
- Surgical intervention was required in 45.6% of cases, including 84 emergency procedures.
- The average patient age was 70.7 years.
Purpose:
- To analyze surgical interventions for colonic diverticulosis and diverticulitis.
- To compare outcomes of emergency versus planned surgeries.
- To evaluate different surgical approaches and their associated mortality rates.
Summary:
- Emergency surgery indications included peritonitis with abscess (72 patients), ileus (10), and massive colon hemorrhage (2).
- Hartmann's procedure was favored for peritonitis and ileus, while anastomosis was used for fibrinous peritonitis.
- Mortality rates were significantly higher for drainage operations (32.3%) than resections (17.2%) and for emergency interventions (22.6%) versus planned operations (4.4%).
Impact:
- Highlights the increased risks associated with emergency surgical interventions for diverticulitis.
- Emphasizes the importance of complete septic focus removal in reducing mortality.
- Suggests a shift towards resection over drainage and the use of primary anastomosis in select cases.
- Notes the routine use of combined antibiotic therapy (aminoglycoside, metronidazole, ampicillin) for aerobic and anaerobic pathogens.