The choice of surgical procedure for peritonitis due to colonic perforation
A. Nespoli, C. Ravizzini, M. Trivella and M. Segala
Department of Emergency Surgery, Centro E. Palini e G. Bevilacqua, Universita di Milano, Italy.
OBJECTIVE: Because the choice of surgical procedure for colonic perforation
is still matter of debate, we retrospectively studied peritonitis caused by
spontaneous colonic perforation to assess predictors of mortality and the
safety of primary resection and anastomosis. DESIGN: Case series. PATIENTS:
We investigated one hundred thirty-six consecutive patients with
peritonitis due to colonic perforation who were surgically treated in an
emergency surgery department. Eighty-one patients underwent primary
resection and anastomosis, thirty-three underwent the Hartmann procedure,
and twenty-two had simple colostomy. The seriousness of peritonitis was
assessed in terms of Hinchey stage, the Mannheim Peritonitis Index (MPI),
and the acute physiology and chronic health evaluation (APACHE) II score.
RESULTS: The overall mortality rate was 20%. The APACHE II scores and MPIs
were lower for survivors than for nonsurvivors. The mortality rate was 6%
for primary resection and anastomosis, 30% for the Hartmann procedure, and
59% for simple colostomy, but the severity scores were significantly lower
in patients who underwent primary resection than those of patients who had
the Hartmann procedure and colostomy, respectively. CONCLUSIONS: Since
primary resection and anastomosis has been shown to be safe, we suggest
that is is proper, even in the presence of peritonitis. In spite of this,
we conclude that the surgical procedure does not influence outcome but that
the mortality rate is related to the severity of peritonitis, accurately
measured by APACHE II score and MPI.
