Acute Complications Of Diverticular Disease Research Articles

Mortality after acute surgery for complications of diverticular disease of the sigmoid colon is almost exclusively due to patient related factors

Auditing the outcome of surgery for complicated diverticulitis of the sigmoid colon is difficult. A comparison of studies is hardly possible because risk factors both in terms of the severity of diverticulitis and patient-related risk factors are neither well described nor standardized. The purpose of this study was to define morbidity and mortality of primary surgery for acute complications of diverticular disease of the sigmoid colon and to identify the relation between risk factors and morbidity and mortality. In a prospective computerized morbidity and mortality registration from 1990 to 2002, 114 patients, who underwent surgery on an acute or urgent base for acute complications of diverticular disease of the sigmoid colon, were identified. In all patients the POSSUM score was calculated. To audit mortality rates a POSSUM based scoring system was introduced. Mortality was 16.7%, and morbidity 71.1%. Higher morbidity rates were significantly related to a higher POSSUM physiological score (P = 0.012) and to older age (P < 0.001). Higher mortality rates also were significantly related to a higher POSSUM physiological score (P < 0.001) and older age (P = 0.003). Patients who died had significantly more sepsis (P < 0.001), multiple organ failure (P = 0.027), cardiac (P < 0.001) and pulmonary (P = 0.013) complications. Gender, operation indication and type of neither surgery nor surgeon had a significant relation with morbidity or mortality. Surgery for acute complications of diverticular disease of the sigmoid colon carries a high morbidity rate and a substantial mortality rate. The majority of deceased patients had severe comorbidity. Post-operative mortality and morbidity are to a large extent driven by patient related factors. Elevated physiological severity scores and a lack of peri-operative management failures express this in the majority of deceased patients.

One-stage procedure in non-elective surgery for diverticular disease complications.

Admission of patients with acute complications of diverticular disease is frequent and operative management remains controversial. The aim of this study was to investigate the efficacy and safety of resection, intra-operative colonic lavage and primary anastomosis in patients who require urgent laparotomy to treat complications of diverticular disease. From January 1992 to December 1999, 124 surgical patients underwent emergency operation for complicated diverticular disease. Resection, intra-operative colonic lavage and primary anastomosis were carried out in 55 patients: four with obstruction, two with massive bleeding and 49 with diverticulitis. In the diverticulitis group, 33 (67.3%) patients presented with localized peritonitis and 16 (32.7%) with generalized purulent peritonitis. No patient with faecal peritonitis was treated by a one-stage procedure. One or more complications were detected in 25 patients (45.4%). Four patients (7.2%) required reintervention. Mortality occurred in four patients (7.2%). Two patients (3.6%) presented with anastomotic leakage. Wound infection was detected in 16 cases (29%). The overall mean (s.d.) Hospital stay was 18.5 (12.1) days. Resection, intra-operative colonic lavage and primary anastomosis provide an alternative procedure for achieving one-stage resection in selected patients who require emergency operation for complication of diverticular disease.

One‐stage procedure in non‐elective surgery for diverticular disease complications

ObjectiveAdmission of patients with acute complications of diverticular disease is frequent and operative management remains controversial. The aim of this study was to investigate the efficacy and safety of resection, intra‐operative colonic lavage and primary anastomosis in patients who require urgent laparotomy to treat complications of diverticular disease.Patients and methodsFrom January 1992 to December 1999, 124 surgical patients underwent emergency operation for complicated diverticular disease. Resection, intra‐operative colonic lavage and primary anastomosis were carried out in 55 patients: four with obstruction, two with massive bleeding and 49 with diverticulitis. In the diverticulitis group, 33 (67.3%) patients presented with localized peritonitis and 16 (32.7%) with generalized purulent peritonitis. No patient with faecal peritonitis was treated by a one‐stage procedure.ResultsOne or more complications were detected in 25 patients (45.4%). Four patients (7.2%) required reintervention. Mortality occurred in four patients (7.2%). Two patients (3.6%) presented with anastomotic leakage. Wound infection was detected in 16 cases (29%). The overall mean (s.d.) Hospital stay was 18.5 (12.1) days.ConclusionResection, intra‐operative colonic lavage and primary anastomosis provide an alternative procedure for achieving one‐stage resection in selected patients who require emergency operation for complication of diverticular disease.

Five-year audit of the acute complications of diverticular disease

The objective of this study was to audit the presentation and outcome for patients admitted with an acute complication of diverticular disease. This study was a retrospective review of 418 admissions with an acute complication of diverticular disease over a 5-year interval. Of the 418 admissions, 15 patients were eventually found to have an alternative diagnosis. Some 403 patients were studied further. The overall mortality rate in this group was 5.7 per cent. A total of 113 patients (28.0 per cent) required an operation and in this group the mortality rate was 17.7 per cent. All deaths occurred in patients who had surgery for septic complications or bowel obstruction. Of the patients who had surgery, 90.2 per cent had a resection of the involved colon. One-third of these had a primary anastomosis; the remainder underwent Hartmann's procedure. Some 83 patients had a stoma fashioned and of these 72 went on to have the stoma closed. The median age of those who died after operation was 80 years. An American Society of Anesthesiologists (ASA) score of 3 or more, concurrent medical disease and shock on admission were all associated with a high mortality rate (P < 0.001). Some 30 per cent of patients were readmitted during this study with a further complication of diverticular disease. The mortality rate after surgery for acute diverticular disease remains excessive and a high-risk group can be identified before operation. A policy of resection and anastomosis appears justified for selected patients. Adopting a practice of interval elective sigmoid colectomy after admission with acute diverticulitis might prevent readmission with further complications.

Five-year audit of the acute complications of diverticular disease

Five-year audit of the acute complications of diverticular disease

Management of the acute complications of diverticular disease: discussion.

Management of the acute complications of diverticular disease: discussion.

Management of the acute complications of diverticular disease: hemorrhage.

Management of the acute complications of diverticular disease: hemorrhage.

Management of the acute complications of diverticular disease: the dangers of colostomy.

Management of the acute complications of diverticular disease: the dangers of colostomy.

Management of the acute complications of diverticular disease

Management of the acute complications of diverticular disease

Management of the acute complications of diverticular disease: peritonitis and septicemia.

Management of the acute complications of diverticular disease: peritonitis and septicemia.

Management of the acute complications of diverticular disease

Management of the acute complications of diverticular disease