EMERGENT ILEOCECECTOMY FOR INFECTION AND INFLAMMATION

The role of right colectomy in controlling inflammatory conditions and intra-abdominal sepsis remains controversial. The objective of this s tudy was to define the outcome following emergency ileocecal resection for infectious and inflammatory causes. Retrospective analysis of 83 consecutive patients who underwent such treatment in a university-affi liated public hospital over a 7-year period was performed. Preoperativ e diagnosis was correct in 54 per cent of patients; CT scan (29 patien ts) did not improve this rate (59%). Free perforation was noted in 16 per cent of patients, and a defined abscess was found in 39 per cent. Common pathologic diagnoses included appendicitis (39%), diverticuliti s (23%), cancer (14%), and Crohn's disease (8%). Primary ileocolic ana stomosis was performed in 74 patients (89%); 9 patients (11%) required an ileostomy. Mean postoperative stay was 10 days, and there was no m ortality. Complications occurred in 15 patients (18%), and 2 required reoperation (2%). Preoperative presence of an abscess was not associat ed with an increased complication rate (16%), but free perforation was associated with a 31 per cent complication rate. Definitive emergency treatment of infectious and inflammatory disease of the ileocecum can be safely accomplished by resection with primary anastomosis in the m ajority of patients, obviating the need for ileostomy and a second ope ration.