Abstract
Background. Colonic malignant obstruction and perforated diverticulitis are acute left sided colonic emergencies (ALSCE) that are typically managed with colorectal resection. Colonic preservation techniques such as laparoscopic lavage and endoscopic stenting have emerged as management options, the safety of which has been debated. We aimed to determine if these alternate colonic preservation techniques result in increased in-hospital mortality. Materials and Methods. Retrospective analysis of prospectively collected data of 210 patients with ALSCE managed from June 2001 to April 2014. Data collected included demographic, pathology type, ASA grading, operative and post-operative progress. Univariable and multivariable logistic regression was performed to determine factors contributing to treatment arm allocation and in-hospital mortality. These were performed on the whole treatment cohort, as well as per pathology subgroup. Results. 210 patients were included. Non-resectional management was attempted in 147 patients (70%), of which 38 (26%) required un-planned colonic resection or died in hospital. Those treated with colonic preservation were younger, had lower ASA scores and had lower Hinchey scores (in the diverticular perforation group) than those in the resection group. Female gender was the only independent predictor of increased in-hospital mortality risk. Importantly, the type of procedure performed (colonic preservation vs. resection) did not predict in-hospital mortality risk. Conclusion. Attempted colonic preservation strategies do not increase the risk of in-hospital mortality in patients presenting with ALSCE. Given the inherent benefits of colonic preservation, these treatment strategies should be considered when managing ALSCE.
Highlights
Left-sided colonic diverticular perforation and malignant obstruction are common surgical emergencies [1] [2]
Colonic malignant obstruction and perforated diverticulitis are acute left sided colonic emergencies (ALSCE) that are typically managed with colorectal resection
Those treated with colonic preservation were younger, had lower Association of Anesthesiology (ASA) scores and had lower Hinchey scores than those in the resection group
Summary
Left-sided colonic diverticular perforation and malignant obstruction are common surgical emergencies [1] [2]. Some presentations dictate the need for immediate resection, such as caecal necrosis from obstruction or uncontrolled faecal fistulae from diverticulitis, immediate resection of the colonic pathology is not mandatory and may be considered over-treatment in majority of patients This is true in patients with malignant obstruction who have incurable disease, and patients with Hinchey 1, 2 or 3 diverticular perforation in which the event often represents the first and only attack of diverticulitis. Nonresectional management was attempted in 147 patients (70%), of which 38 (26%) required unplanned colonic resection or died in hospital Those treated with colonic preservation were younger, had lower ASA scores and had lower Hinchey scores (in the diverticular perforation group) than those in the resection group. Given the inherent benefits of colonic preservation, these treatment strategies should be considered when managing ALSCE
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