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Liebert Cw, DeWeese Bm (1981)
Primary resection without anastomosis for perforation of acute diverticulitis.Surgery gynecology & obstetrics, 152
Linder MM Wacha H (1987)
Mannheim Peritonitis Index: prediction of risk of death from peritonitis: construction of a statistical and validation of an empirically based indexTheoret Surg, 1
T. Eisenstat, R. Rubin, E. Salvati (1983)
Surgical management of diverticulitisDiseases of the Colon & Rectum, 26
D. Nagorney, M. Adson, J. Pembérton (1985)
Sigmoid diverticulitis with perforation and generalized peritonitisDiseases of the Colon & Rectum, 28
R. Smithwick (1942)
EXPERIENCES WITH THE SURGICAL MANAGEMENT OF DIVERTICULITIS OF THE SIGMOID.Annals of surgery, 115 6
G. Nunes, A. Robnett, R. Kremer, R. Ahlquist (1979)
The Hartmann procedure for complications of diverticulitis.Archives of surgery, 114 4
Rubin RJ Eisenstat TE (1983)
Surgical management of diverticulitis: the role of the Hartmann procedureDis Colon Rectum, 24
E. Draper, D. Wagner, J. Zimmerman (1985)
Prognosis in Acute Organ‐System FailureAnnals of Surgery, 202
M. Killingback (1983)
Management of perforative diverticulitis.The Surgical clinics of North America, 63 1
James Peoples, Deborah Vilk, John Maguire, Dan Elliott (1990)
Reassessment of primary resection of the perforated segment for severe colonic diverticulitis.American journal of surgery, 159 3
Hinchey Ej, Schaal Pg, Richards Gk (1978)
Treatment of perforated diverticular disease of the colon.Advances in Surgery, 12
E. Dellinger, M. Wertz, J. Meakins, J. Solomkin, M. Allo, R. Howard, R. Simmons (1985)
Surgical infection stratification system for intra-abdominal infection. Multicenter trial.Archives of surgery, 120 1
L. Auguste, E. Borrero, L. Wise (1985)
Surgical management of perforated colonic diverticulitis.Archives of surgery, 120 4
Smithwick RH (1942)
Experience with surgical management of diverticulitis of sigmoidAnn Surg, 115
Schaal PGH Hinchey EJ (1978)
Advances in Surgery, 12
Wertz MJ Dellinger EP (1985)
Surgical infection stratification system for intra-abdominal infectionArch Surg, 120
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) References 1. Nagorney DN, Adson MA, Pemberton JH. Sigmoid diverticulitis with perforation and generalized peritonitis . Dis Colon Rectum . 1985;28:71-75.Crossref 2. Killinback ZH. Management of perforative diverticulitis . Surg Clin North Am . 1983;63:97-115. 3. Liebert CW, De Weese BM. Primary resection without anastomosis for perforation of acute diverticulitis . Surg Gynecol Obstet . 1981;152:30-32. 4. Nunes GC, Robnett AH, Kremer RM, Ahlquist RE Jr. The Hartmann procedure for complications of diverticulitis . Arch Surg . 1979;114:425-429.Crossref 5. Eisenstat TE, Rubin RJ, Salvati EP. Surgical management of diverticulitis: the role of the Hartmann procedure . Dis Colon Rectum . 1983;24:429-432.Crossref 6. Hinchey EJ, Schaal PGH, Richards GK. Treatment of perforated diverticular disease of the colon . In: Rob C, ed. Advances in Surgery . St Louis, Mo: Mosby—Year Book; 1978;12:85. 7. Wacha H, Linder MM, Feldman U. Mannheim Peritonitis Index: prediction of risk of death from peritonitis: construction of a statistical and validation of an empirically based index . Theoret Surg . 1987;1:169-177. 8. Knaus WA, Draper EA, Wagner DP, Zimmerman JE. Prognosis in acute organ-system failure . Ann Surg . 1985;202:685-693.Crossref 9. Dellinger EP, Wertz MJ, Meakins JL, et al. Surgical infection stratification system for intra-abdominal infection . Arch Surg . 1985;120:21-26.Crossref 10. Smithwick RH. Experience with surgical management of diverticulitis of sigmoid . Ann Surg . 1942;115:969-975.Crossref 11. Peoples JB, Vilk DR, Maguire JP, Elliott DW. Reassessment of primary resection of the perforated segment of severe colonic diverticulitis . Am J Surg . 1990; 159:291-294.Crossref 12. Auguste L, Borrero E, Wise L. Surgical management of perforated colonic diverticulitis . Arch Surg . 1985;120:450-452.Crossref
Archives of Surgery – American Medical Association
Published: Jul 1, 1993
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