The effects of on-table colonic irrigation followed by primary sigmoid resection and anastomosis for acutely complicated diverticular sigmoiditis were prospectively studied in 15 patients between August 1993 and December 1996. Patients and methods: Ten patients had a diverticular perforation with a perisigmoid abscess (6 patients) or generalised peritonitis (4 patients), 5 had a complete sigmoid obstruction. Antegrade colonic irrigation was carried out with a mean volume of 7.5 l. All patients received a double or triple antibiotic regimen. The anastomosis was always extra peritoneal, handsewn in 9 patients and stapled (Knight-Griffen) in 6. Six patients with severe peritonitis had a proximal stoma. Results: Postoperative mortality and clinical anastomotic dehiscence were nil. Three patients developed hypothermia (< 35°C) during the irrigation; 4 patients (26.6%) developed a wound infection. 1 a Candida Albicans septicaemia and 1 an abscess in the right iliac fossa which was drained percutaneously. All complications had a favourable outcome; all colostomies were closed within 4 months. Conclusions: This study confirms that single stage surgery preceded by on-table irrigation for acutely complicated sigmoid diverticulitis gives excellent results and is a safe and effective alternative to Hartmann's procedure.
Intraoperative colonic irrigation in the treatment of complicated sigmoid diverticulitis
Tiberio G. A. M.;
1997-01-01
Abstract
The effects of on-table colonic irrigation followed by primary sigmoid resection and anastomosis for acutely complicated diverticular sigmoiditis were prospectively studied in 15 patients between August 1993 and December 1996. Patients and methods: Ten patients had a diverticular perforation with a perisigmoid abscess (6 patients) or generalised peritonitis (4 patients), 5 had a complete sigmoid obstruction. Antegrade colonic irrigation was carried out with a mean volume of 7.5 l. All patients received a double or triple antibiotic regimen. The anastomosis was always extra peritoneal, handsewn in 9 patients and stapled (Knight-Griffen) in 6. Six patients with severe peritonitis had a proximal stoma. Results: Postoperative mortality and clinical anastomotic dehiscence were nil. Three patients developed hypothermia (< 35°C) during the irrigation; 4 patients (26.6%) developed a wound infection. 1 a Candida Albicans septicaemia and 1 an abscess in the right iliac fossa which was drained percutaneously. All complications had a favourable outcome; all colostomies were closed within 4 months. Conclusions: This study confirms that single stage surgery preceded by on-table irrigation for acutely complicated sigmoid diverticulitis gives excellent results and is a safe and effective alternative to Hartmann's procedure.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
