Scientific Online Resource System

Scripta Scientifica Medica

Complicated colonic diverticular disease-indications and strategies for surgical treatment

E. Arabadzhieva, S. Bonev, A. Jonkov, D. Bulanov, V. Dimitrova

Abstract

Purpose: Colonic diverticular disease is a common disease worldwide. Complicated diverticulitis is determined by presence of perforation, abscess, phlegmon, stricture, obstruction, fistula or hemorrhage. It is an indication for operative management. The aim of the present study was to determine the indications for surgery of complicated diverticular disease, to compare resection with primary anastomosis to Hartmann`s procedure as the optimal urgent operative strategy for patients with complicated acute diverticulitis and to analyze the factors affecting the outcome.

Material and methods: Between 1999 and 2012, 250 patients with symptomatic colonic diverticular disease were hospitalized in the Department of General and Hepatopancreatic Surgery, University Hospital Alexandrovska of Sofia. Of them, 39 patients with complicated colonic diverticulitis were surgically treated. Several factors that could influence on the choice of surgical strategy were analyzed by means of SPSS 19.0.1 statistical package.

Results: Surgery was applied in 31 patients with perforation, one patient with diverticular bleeding, five patients with fistulas and two patients with bowel obstruction based on diverticular disease.

Conclusion: The surgical treatment of complicated diverticular disease, especially of that with peritonitis, remains a challenge. The performance of resection with primary anastomosis with or without protective stoma in selected patients is an alternative to Hartmann`s procedure.


Keywords

complicated colonic diverticular disease; perforation; Hartmann`s procedure; primary anastomosis; protective stoma

Full Text


References

Abbas, S. Resection and primary anastomosis

in acute complicated diverticulitis, a systematic

review of the literature.- Int. J. Colorectal Dis., 22,

, No 4, 351-357.

Almy, T. P., D. A. Howell. Medical progress.

Diverticular disease of the colon.- New Engl. J.

Med., 302, 1980, No 6, 324-331.

Bauer, V. Emergency management of diverticulitis.-

Clin. Colon Rectal Surg., 22, 2009, No 3, 161-168.

Baxter, N. N. Emergency management of

diverticulitis.- Clin. Colon Rectal Surg., 17, 2004, No

, 177-182.

Bordeianou, L., R. Hodin. Controversies in the

surgical management of sigmoid diverticulitis.- J.

Gastrointest. Surg., 11, 2007, No 4, 542-548.

Breitenstein, S., A. Kraus, D. Hahnloser, M.

Decurtins, P. A. Clavien, N. Demartines.

Emergency left colon resection for acute

perforation: primary anastomosis or Hartmann`s

procedure? A case-matched control study.- World J.

Surg., 31, 2007, No 11, 2117-2124.

Constantinides, V. A., P. P. Tekkis, T. Athanasiou,

O. Aziz, S. Purkayastha, F. H. Remzi, et al. Primary

resection with anastomosis vs. Hartmann`s

procedure in nonelective surgery for acute colonic

diverticulitis: a systematic review.- Dis. Colon

Rectum, 49, 2006, No 7, 966-981.

Constantinides, V. A., A. Heriot, F. Remzi, A.

Darzi, A. Senapati, V. W. Fazio, et al. Operative

strategies for diverticular peritonitis: a decision

analysis between primary resection and

anastomosis versus Hartmann`s procedures.- Ann.

Surg., 245, 2007, No 1, 94-103.

Gregg, R. O. The place of emergency resection in

the management of obstructing and perforating

lesions of the colon.- Surgery, 27, 1955, No 5,

-761.

Hussain, A., H. Mahmood, G. Subhas, S. El-

Hasani. Complicated diverticular disease of the

colon, do we need to change the classical approach,

a retrospective study of 110 patients in southeast

England.- World J. Emerg. Surg., 3, 2008, 5. doi:

1186/1749-7922-3-5.

Klarenbeek, B. R. Surgical challenges in

diverticular disease. Doctoral thesis. Amsterdam,

Vrije Universiteit, 2010. 184 p. available on http://

hdl.handle.net/1871/16040

O`Sullivan, G. C., D. Murphy, M. G. O`Brien, A.

Ireland. Laparoscopic management of generalized

peritonitis due to perforated colonic diverticula.-

Am. J. Surg., 171, 1996, No 4, 432-434.

Painter, N. S., D. P. Burkitt. Diverticular disease

of the colon: a deficiency disease of Western

civilization.- Br. Med. J., 2, 1971, No 5759, 450-454.

Parks, T. G. Natural history of diverticular disease

of the colon.- Clin. Gastroenterol., 4, 1975, No 1,

-69.

Rafferty, J., P. Shellito, N. H. Hyman, W. D. Buie;

Standards Committee of American Society of

Colon and Rectal Surgeons. Practice parameters

for sigmoid diverticulitis.- Dis. Colon Rectum, 49,

, No 7, 939-944.

Rothenberger, D. A., J. Garcia-Aguilar. Diverticular

disease of the colon.- In: Current surgical therapy.

J. L. Cameron, ed. St Louis, MO, Mosby Inc., 1998,

-179.

Salem, L., D. R. Flum. Primary anastomosis

or Hartmann`s procedure for patients with

diverticular peritonitis? A systematic review.- Dis.

Colon Rectum, 47, 2004, No 11, 1953-1964.

Stocchi, L. Current indications and role of surgery

in the management of sigmoid diverticulitis.-

World J. Gastroenterol., 16, 2010, No 7, 804-817.

Stollman, N., J. B. Raskin. Diverticular disease of

the colon.- Lancet, 363, 2004, No 9409, 631-639.

Zeitoun, G., A. Laurent, F. Rouffet, J. Hay, A.

Fingerhut, J. Paquet, et al. Multicentre, randomized

clinical trial of primary versus secondary sigmoid

resection in generalized peritonitis complicating

sigmoid diverticulitis.- Br. J. Surg., 87, 2000, No 10,

-1374.




DOI: http://dx.doi.org/10.14748/ssm.v45i0.875
Array
Article Tools
Email this article (Login required)
About The Authors

E. Arabadzhieva
Medical University of Sofia
Bulgaria

Department of General and Hepatopancreatic Surgery, University Hospital Alexandrovska of Sofia

S. Bonev
Medical University of Sofia
Bulgaria

Department of General and Hepatopancreatic Surgery, University Hospital Alexandrovska of Sofia

A. Jonkov
Medical University of Sofia
Bulgaria

Department of General and Hepatopancreatic Surgery, University Hospital Alexandrovska of Sofia

D. Bulanov
Medical University of Sofia
Bulgaria

Department of General and Hepatopancreatic Surgery, University Hospital Alexandrovska of Sofia

V. Dimitrova
Medical University of Sofia

Department of General and Hepatopancreatic Surgery, University Hospital Alexandrovska of Sofia

Font Size


|