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Diverticulitis with perforation into the peritoneal cavity

D L Nahrwold, W E Demuth

    Annals of Surgery
    |January 1, 1977
    PubMed
    Summary
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    Emergency surgery for perforated sigmoid diverticulitis is crucial. Sigmoid colectomy with temporary colostomy and peritoneal toilet offers an effective treatment option, with a high survival rate and few complications.

    Area of Science:

    • Gastroenterology
    • Surgical Gastroenterology
    • Abdominal Surgery

    Background:

    • Perforated sigmoid diverticulitis leading to generalized peritonitis necessitates emergency surgery.
    • The optimal surgical procedure for this condition remains debated.

    Purpose of the Study:

    • To evaluate the efficacy of sigmoid colectomy, temporary end colostomy, and peritoneal toilet in treating perforative sigmoid diverticulitis.

    Main Methods:

    • Ten consecutive patients with perforative sigmoid diverticulitis underwent sigmoid colectomy, temporary end colostomy, and peritoneal toilet.
    • Preoperative clinical findings and postoperative outcomes were analyzed.

    Main Results:

    • Eight out of ten patients had a correct preoperative diagnosis.

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  • The predominant symptoms included severe abdominal pain, tenderness, fever, and elevated white blood cell count.
  • The procedure resulted in a high survival rate (90%) with only four minor complications.

    • Conclusions:

    • Sigmoid colectomy, temporary end colostomy, and peritoneal toilet is an efficacious therapy for perforative diverticulitis with free communication to the peritoneal cavity.
    • Accurate diagnosis is often achievable preoperatively based on clinical findings, particularly localized tenderness in the left lower quadrant and suprapubic areas.