SURGICAL TREATMENT IN COLONIC ACUTE DIVERTICULITIS

Abstract

Background: Colonic acute diverticulitis presents in patients that suffered from colonic diverticula in 10-25% of cases higher percentage in the elder patient. Colonic acute diverticulitis mortality leads high rates in over 70 yers old patients with a value a upper than 75-80%. Perforation and diffuse peritonitis are the more serious complications. Accurate clinical staging followed by correct surgical option are the base of the therapeutical success.

Methods: Between January 1995 and June 2000 we studied by a retrospective analysis 56 patients (34M/22F), mean age 67, hospitalized cause acute perforate colonic diverticulitis, all patients were recorded in order their clinical conditions APS score and Hinchey staging of the disease. At the time of the recovery all patients underwent at clinical examination, abdominal ultrasound, plane X-ray, and bloody tests. Surgical operations performed were: PRA; PRA and protective colostomy; Hartmann procedure. In the patients with APS score >6-10 and aged >70 Hartmann procedure was performed.

Results: Overall mortality was 9% (5 pazienti), overall morbility was 40%. On the basis of the I and II Hinchey stage mortality rate was 0%. In the III stage was recorded mortality of 4% and 33 % in IV stage. Complication were: 6 anastomitic lekage; 7 infections of the laparotomic wound; 1 incisional hernia; 2 lekages of the stomia; 3 stomitis; 5 proctitis.

Conclusion: Terapeutical choise treatment has to consider Hinchey stage and APS score. Hartmann procedure is indicated in stage III-IV with score APS >8-10. For the other patients primary resection anastomosis and if is necessary associated colostomy is the tratment recomanded.