 |
|
The Choice of Surgical Procedure for Peritonitis due to Colonic Perforation
Angelo Nespoli, MD;
Claudia Ravizzini, MD;
Matilde Trivella, MD;
Marco Segala, MD
Arch Surg. 1993;128(7):814-818.
Abstract
| |
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.
(Arch Surg. 1993;128:814-818)
Author Affiliations
From the Department of Emergency Surgery, Centro E. Palini e G. Bevilacqua, Universita di Milano, and IRCCS, Ospedale Maggiore Policlinico, Milan, Italy.
 CiteULike  Connotea  Del.icio.us  Digg  Reddit  Technorati  Twitter
What's this?
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
Operative Management of Diverticular Emergencies: Strategies and Outcomes
Schwesinger et al.
Arch Surg 2000;135:558-563.
ABSTRACT
| FULL TEXT
Emergency Surgery for Colon Cancer in the Aged
Koperna et al.
Arch Surg 1997;132:1032-1037.
ABSTRACT
Prognosis and Treatment of Peritonitis: Do We Need New Scoring Systems?
Koperna and Schulz
Arch Surg 1996;131:180-186.
ABSTRACT
|
