PRIMARY RESECTION WITH AND WITHOUT ANASTOMOSIS FOR PERFORATION OF ACUTE DIVERTICULITIS

The results of management of perforated large bowel diverticulitis wer e retrospectively studied over a 7-year period. 38 patients underwent operation, 20 for generalized peritonitis, 12 for local peritonitis, 5 for colovesical fistula and 1 for colovaginal fistula. The mean age o f patients was 63 years (range 30-85 years). Depending on the symptoms , the spreading of the peritonitis and associated cardiovascular and p ulmonary disease and diabetes mellitus, 4 types of operation were perf ormed : primary left hemicolectomy and anastomosis with and without de functioning colostomy, Hartmann procedure, suture and drainage with di verting colostomy. The overall mortality was 10.5% : resection and pri mary anastomosis entailed 3.8% mortality (1 case), while 3 deaths were observed in the 8 patients group having underwent an Harmann procedur e (37.5%). Drainage and/or diverting colostomy performed in 5 patients entailed no hospital mortality, but was followed by a 80% complicatio n rate, requiring reoperation and several hospital admissions. The low mortality and morbidity rates obtained in the group having primary re section and anastomosis encourage wider application of this operation for perforated acute diverticulitis. Even the Hartmann procedure allow s removal of the diseased colon but in a great proportion of cases rec onstitution of continuity is not performed ; nevertheless staged opera tion entailing major mortality and morbidity, expose these aged patien ts to remarkable hazard. Prerequisite of safe primary excision and ana stomosis is vigorous intraperitoneal lavage and drainage, by the case associated to on table large bowel irrigation if concomitant obstructi on is present.