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The Choice of Surgical Procedure for Peritonitis due to Colonic Perforation

The Choice of Surgical Procedure for Peritonitis due to Colonic Perforation 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 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

The Choice of Surgical Procedure for Peritonitis due to Colonic Perforation

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References (16)

Publisher
American Medical Association
Copyright
Copyright © 1993 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.1993.01420190110014
Publisher site
See Article on Publisher Site

Abstract

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

Journal

Archives of SurgeryAmerican Medical Association

Published: Jul 1, 1993

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