Perforated sigmoid diverticulitis with spreading peritonitis

Abstract

The mortality in this series of nineteen patients with perforated sigmoid diverticulitis with spreading peritonitis was 47 per cent. Persistent peritonitis resulting in death and regional complications consisting of inflammatory bowel obstruction, fecal fistula, pelvic phlebitis, intraperitoneal abscess, and upper gastrointestinal bleeding are believed to be related to the therapeutic inadequacy of a proximal colostomy with drainage of the peritoneal cavity. In the presence of free communication between the perforation and the general peritoneal cavity, continued bacterial contamination occurs because of leakage of feces retained in the colon between the colostomy and the site of perforation. In consonance with other recent reports, encouraging results in three patients have been achieved by elimination of this source of continued contamination by exteriorization of the colon at the site of perforation or by resection with proximal end colostomy. The mortality in this series of nineteen patients with perforated sigmoid diverticulitis with spreading peritonitis was 47 per cent. Persistent peritonitis resulting in death and regional complications consisting of inflammatory bowel obstruction, fecal fistula, pelvic phlebitis, intraperitoneal abscess, and upper gastrointestinal bleeding are believed to be related to the therapeutic inadequacy of a proximal colostomy with drainage of the peritoneal cavity. In the presence of free communication between the perforation and the general peritoneal cavity, continued bacterial contamination occurs because of leakage of feces retained in the colon between the colostomy and the site of perforation. In consonance with other recent reports, encouraging results in three patients have been achieved by elimination of this source of continued contamination by exteriorization of the colon at the site of perforation or by resection with proximal end colostomy.