Resection and primary anastomosis for diverticulitis with perforation and peritonitis

Primary resection is the treatment of choice for diverticulitis of the colon with perforation and generalized peritonitis. Although there has been controversy concerning the management of the bowel ends after resection, for the last 20 years immediate anastomosis has been gaining increasing support. Between 1970 and 1981, at the Hôpital du Sacré-Coeur in Montreal, 15 patients having diverticulitis with perforation and diffuse spreading peritonitis who fulfilled specific criteria were treated by primary resection of the perforated segment of bowel and immediate anastomosis. The criteria for operation were : (a) the bowel must not be distended; (b) the bowel should be empty of feces; (c) edema of bowel wall at the resection site must be minimal; (d) the distal segment of colon should be above the peritoneal reflection; (e) there should be no fecal contamination; (f) the patient's general condition should be reasonably good. If these criteria were met, the procedure was safe and gave satisfactory results. In the authors' series, postoperative hospital stay was reduced considerably (it averaged 11 days). There was one anastomotic pulmonary edema.