Treatment of diverticulitis of the colon: Choice of operation

Abstract

Summary Surgical treatment is indicated not only for the complications of diverticulitis of the colon but also for chronic diverticulitis with recurring attacks. In such cases operation should be advised in order to prevent the grave complications of perforation, fistula and obstruction. Definitive surgical treatment should include resection of the diseased segment of bowel, with ultimate restoration of intestinal continuity. In some cases resection of the involved sigmoidal loop is insufficient because of the presence of numerous diverticula in the descending or transverse colon. In such cases left hemicolectomy is preferable. In rare instances subtotal colectomy is indicated. A permanent colostomy is almost nerver necessary. A three-stage operation, consisting of right transverse colostomy, resection and closure of the colostomy, is the safest procedure. It is indicated in cases of perforation with pelvic abscess or general peritonitis, in patients with obstruction and in patients with fistula of the bladder or other sites. The one-stage operation may be safely employed in patients with recurring episodes of diverticulitis, in those with hemorrhage and in those cases in which carcinoma is suspected or cannot be excluded. Obstructive resection and combined abdominoperineal resection are practically never indicated. In a series of patients treated surgically at the University of Michigan Hospital, hemorrhage as a complication was not an important problem; it was noted in about 17 per cent of the cases. Such bleeding is usually very moderate and intermittent. When hemorrhage is the chief or sole symptom and when it occurs frequently, carcinoma should be suspected and operation should not be delayed too long. In our group of cases fistula of the bladder did not present any particular technical problems. When a three-stage operation was performed, the fistula had completely or practically closed by the time of the resection.