for Complicated Colonic Diverticula
Full Article (PDF file)
Gheorghe Funariu, Vasile Bintintan, Radu Seicean
1st Surgical Clinic, University of Medicine and Pharmacy, Cluj-Napoca
aim of this retrospective study was to evaluate the
emergency surgical treatment of life-threatening complications
of colonic diverticula.
and method. In the last 11 years, 22 of 101 patients
with colonic diverticula (22.1%) underwent urgent surgery for
acute complications: perforated gangrenous diverticulitis with
generalized peritonitis (n=8) or pericolic abscess (n=8), acute
bowel obstruction (n=4) and severe diverticular bleeding (n=2).
In all patients with diffuse peritonitis or acute obstruction
the indication for surgery was decided on clinical basis and
the complicated diverticula were recognized only intra-operatively.
Emergency surgical strategy differed according to the type of
complication and the biologic condition of the patient: segmental
colectomy and primary anastomosis for diverticular perforation
(n=4), colonic stenosis (n=3) or diverticular bleeding (n=2);
Hartmann resection with late reconnecting anastomosis in patients
with diverticular perforation (n=5) or colonic obstruction (n=1);
diverticulectomy with peritoneal drainage (n=2) and colostomy
and drainage followed by secondary colectomy (n=5) for diverticular
perforations in patients with poor general condition. Only one
patient (4.5%) died post-operatively of multiple organ failure
from generalized peritonitis. There was no anastomotic leakage
in patients with primary anastomosis. Six patients (27.2%) developed
wound infection. Hospital stay ranged between 11 and 60 days,
significantly longer in cases with two-stage operations.
Primary colectomy with immediate or delayed anastomosis is the
best surgical procedure for acute divericular complications
in patients with good biologic status. Two-stage operations
such as colostomy and drainage coupled with late colectomy remain
the viable alternative in patients with advanced disease and
critical biologic condition.
surgery - colonic diverticula - diverticular perforation - colonic
stenosis - diverticular bleeding