Closure of colostomy following sigmoid colon resection for perforated diverticulitis

Hartmann resection has been the treatment of choice for perforated diverticulitis of the sigmoid colon at the Vancouver General Hospital for nearly 20 years. A retrospective analysis of 70 patients who had the colonic stomas closed following the Hartmann resection was done. A modified Hartmann resection for the initial procedure has been recommended on the basis of fewer complication and shorter hospital stay when the closure operation is performed. The modification consists of the creation of a distal mucus fistula rather than suturing the rectum closed. To facilitate the creation of a distal mucus fistula, it is suggested that less sigmoid colon be resected at the time of the initial operation. The colon can be assessed for residual diverticular disease later and more resected at the later closure operation if required.