Nonresective Emergency Management of Perforated Sigmoid Diverticulitis: A Case Report

This case report aims to demonstrate that it is not always necessary to resect the sigmoid colon in emergency surgery for perforated diverticulitis. We have found that in several cases, most of the sigmoid is in fact quite healthy, and the perforation is limited to a very small area. This is demonstrated by a recent case where a 44-year-old male presented to our care with severe sepsis and extensive peritonitis with abscess formation. At emergency surgery, the abscess was drained, but the abdominal sepsis was too extensive to permit safe resection and primary anastomosis. The sigmoid was severed at the site of perforation, and the distal stump was oversewn and tacked near the colostomy site with no resection of the sigmoid. Four months later, a contrast enema showed that most of the distal sigmoid was normal. It was therefore easy and safe to do colostomy reversal with minimal excision of the margins on each side. In the local/Caribbean setting, we could avoid permanent colostomy by minimizing/avoiding resection of otherwise normal sigmoid colon in perforated diverticulitis. After the sepsis has settled, the colon can be studied to determine how much colon, if any, should be resected at ostomy reversal.