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Operative Management of Diverticular Emergencies
Strategies and Outcomes
Wayne H. Schwesinger, MD;
Carey P. Page, MD;
Harold V. Gaskill III, MD;
Ronald M. Steward, MD;
Shailendra Chopra, MD;
William E. Strodel, MD;
Kenneth R. Sirinek, MD, PhD
Arch Surg. 2000;135:558-563.
Hypothesis A selective surgical approach using either a 1- or a 2-stage resection is relatively safe and effective in the management of acute complicated colonic diverticulosis.
Design A consecutive cohort study.
Setting A university hospital.
Patients Eighty-nine consecutive patients who underwent emergency operations for diverticular disease between July 1, 1984, and June 30, 1999. There were 53 male and 36 female patients (mean age, 47 years). The ethnic background was predominantly Mexican American (58 patients [65.2%]).
Interventions Resections of the affected colon (n=83) plus construction of a Hartmann pouch or mucous fistula (n=72) or primary anastomosis (n=11).
Main Outcome Measures Morbidity, mortality, and length of hospital stay.
Results Sixty-eight operations were performed for perforation at an annual rate that has increased greater than 75% in the past 15 years. Another 14 patients underwent operations for obstruction, and 7 underwent operations to control unremitting hemorrhage. Surgical therapy included resection of the affected segment of the bowel in 83 (93%) of the 89 patients, and a Hartmann pouch or mucous fistula was added in 72 (81%). A primary anastomosis was performed in 4 (80%) of 5 right-sided lesions but in only 7 (8%) of 84 left-sided lesions. Morbidity occurred in 38 (43%) of the 89 patients, and the mortality was 4%, with 4 deaths occurring secondary to sepsis in high-risk patients with perforations (n=3) or obstructions (n=1). The average length of hospital stay was 19.7 days (range, 5-80 days).
Conclusions Emergency operations for diverticular disease are uncommon but may be associated with substantial morbidity and occasional mortality. Complicated diverticulosis may present at a relatively young age, and perforated forms appear to be increasing rapidly in prevalence. Most diverticular lesions can be satisfactorily managed using a selective approach based on resection with either a primary anastomosis or a temporary colostomy.
From the Departments of Surgery (Drs Schwesinger, Page, Gaskill, Steward, Strodel, and Sirinek) and Radiology (Dr Chopra), The University of Texas Health Science Center at San Antonio.
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