[Prospective national study of complicated diverticulitis in Great Britain]

Three hundred cases of complicated diverticular disease were entered into a national audit organised by the Surgical Research Society from 30 hospitals between 1985 and 1988. Admission complications included acute phlegmon (n = 104), pericolic abscess (n = 34), purulent peritonitis (n = 40), large bowel obstruction (n = 31), faecal peritonitis (n = 23), pericolic abscess complicated by fistula (n = 28) and lower GI bleeding (n = 40). The overall mortality was only 11% (4% acute phlegmon, 27% purulent peritonitis, 12% pericolic abscess, 48% faecal peritonitis, 6% large bowel obstruction, 2.5% bleeding, 3.5% fistula). Acute phlegmon was managed non-operatively in 75% and by resection in 23%. Purulent peritonitis was generally managed by Hartmann resection (62%) or by resection and primary anastomosis (15%). Similarly pericolic abscess was usually managed by Hartmann resection (38%) or resection and primary anastomosis (35%). The principal operation for faecal peritonitis was Hartmann resection (83%). Large bowel obstruction was either managed conservatively (13%), by Hartmann resection (29%) or by resection and primary anastomosis with and without a proximal stoma (42%). Most fistulas associated with an abscess were managed by resection and primary anastomosis (82%) and acute GI bleeding was usually managed non-operatively (90%).