Surgical treatment of the perforated colon with peritonitis

The authors present their experience on 85 perforations of the colon treated at the Clinic of Surgery, Charles University Hospital in Prague between 1980-1993 and compare them with the results published in the literature. The most frequent cause of perforation was diverticulitis 35, followed by tumorous process 34, artificial injury 10, local ischemic lesion 4 and ulceration 1. All patients with perforation of the colon suffered from peritonitis. The present paper surveys our patients and the causes of perforation. We find it essential to remove the affected part of the colon as the primary surgical approach by performing either a resection combined with primary anastomosis. Hartmann procedure, or resection with terminal colostomy and mucous fistula. However, the optimum therapeutic scheme could only be applied to slightly less than a half of the patients. In the rest, unfavourable conditions, such as poor overall physical state of the patients, extensive local findings, dissemination of the tumours, or extreme progression of the stercoral peritonitis have precluded it. In these particular cases we had to perform colostomy and drainage with significantly poorer results. From the investigation ensues that primary resection of the colon during perforation should be used in all instances where the general condition of the patients, the surgical position and the extent of peritonitis permit.