Diverticulitis of the Colon

Abstract

Summary 1.In 14,695 examinations of the colon by roentgen studies, diverticula were demonstrated in approximately one of every eight patients. 2.Surgical treatment was employed in only 53 cases of colonic diverticulitis during a fifteen year period. The chief indications were the complications of the disease, e.g., perforation with peritonitis, localized abscess, fistula or obstruction. 3.In certain cases accurate differentiation between diverticulitis of the left colon and neoplasm was impossible and hence resection was imperative. 4.In 7 cases proven by resection carcinoma and diverticulitis were found to co-exist. 5.Rectal hemorrhage occurred in 9 of 53 patients with diverticulitis only, an incidence of 17 per cent. The bleeding was massive in character in only one instance. On the contrary in the group of cases in which both diverticulitis and cancer were present, hemorrhage was a common complaint and often was the major or sole symptom. Hence, when bleeding is a prominent symptom in cases of roentgenologically demonstrated diverticulitis, surgical treatment should not be delayed. 6.There were only two cases of diverticulitis of the proximal colon which required definitive surgical treatment. One of these was a case of solitary diverticulum of the cecum, and the other was one of diverticulitis of the transverse colon. 7.Simple or emergency surgical procedures were employed in 14 cases of diverticulitis of the distal colon, with the following results a.Following simple incision and drainage of abscesses, there was one postoperative death, two long-term survivals without recurrence, and one death from a subsequent perforation eight years later. b.Of the 6 patients treated by colostomy, there was one satisfactory result following subsequent closure. Three patients died 3 months to 5 and one-half years later, the colostomies never having been closed. One patient is living at 12 years free of symptoms, but with a colostomy and, in one case, resection is contemplated prior to closure of the colostomy. c.Cecostomy resulted in 2 operative deaths while one patient is living and free of symptoms 2 and one-half years following operation. 8.In 37 cases of distal colon lesions, resections were performed. The surgical procedures employed in these cases were a.Three-stage operation—17 b.Resection with primary anastomsis—14 c.Obstructive resection—three; d.Abdominoperineal resection—two; and e.Subtotal colostomy—one. 9.In this group of 37 resections there was 1 operative death while 5 other patients have been followed for less than 1 year. The 31 cases suitable for evaluation of late results are classified as follows: Excellent—12; satisfactory—15; unsatisfactory—2. Two patients were lost to follow-up. 10.In view of the low mortality rate for resection, this procedure should be advised more frequently than it has been in the past for patients with diverticulitis with recurrent or persistent symptoms in order to prevent the development of serious complications. In such cases a one-stage surgical procedure is ordinarily feasible.