[Diverticular peritonitis. Clinical, prognosis and therapeutic aspects]

The results of diagnosis and management of perforated sigmoid diverticulitis were studied retrospectively over a 10 years period. 23 patients underwent operation, 17 for generalized peritonitis and 6 for local peritonitis. The mean age of patients was 65.7 years. Diverticular disease were known previously in 5 patients (21%) and complicated (diverticulitis) in 2 patients (8.6%). Depending on the symptoms and the spreading of the peritonitis 4 types of the disease can be described: primary generalized peritonitis, secondary generalized peritonitis, progressive generalized peritonitis and local peritonitis. Hartman procedure was performed in 16 patients, and proximal colostomy with drainage in 6 patients, ideal resection in one. The over all mortality was 34.7%, 43% after resection, 16% after conservatrice procedure, depending on the clinical status, duration of symptoms, type of peritonitis, surgical procedure. Improved results will require early diagnosis, adapted surgical procedure, appropriate antibiotics therapy and extension of prophylactic segmentation colectomie after one acute diverticulitis.