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Clin Colon Rectal Surg 2021; 34(02): 104-112
DOI: 10.1055/s-0040-1716702
Review Article

Laparoscopic Lavage in the Management of Hinchey III/IV Diverticulitis

Maria X. Kiely
1   Department of Surgery, Division of Colon and Rectum Surgery, Tufts Medical Center, Boston, Massachusetts
,
Mengdi Yao
1   Department of Surgery, Division of Colon and Rectum Surgery, Tufts Medical Center, Boston, Massachusetts
,
Lilian Chen
1   Department of Surgery, Division of Colon and Rectum Surgery, Tufts Medical Center, Boston, Massachusetts
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Abstract

Diverticulitis manifestations may cover a spectrum of mild local inflammation to diffuse feculent peritonitis. Up to 35% of patients presenting with diverticulitis will have purulent (Hinchey grade III) or feculent (Hinchey grade IV) contamination of the abdomen, with a high-associated morbidity and mortality. Surgical management may involve segmental resection with or without restoration of bowel continuity. However, emergency resection for diverticulitis can be associated with high mortality rates, as well as low stoma reversal rates at 1 year. Therefore, laparoscopic peritoneal lavage has been proposed for use in selected patients with purulent peritonitis. The topic of laparoscopic peritoneal lavage for the treatment of perforated diverticulitis in the literature has been controversial. Our review of the recent data show that laparoscopic lavage may be safe and feasible in select patients with similar rates of mortality and major morbidity. There is, however, a concern regarding an associated higher rate of postoperative abscess and early reintervention risk.

Keywords

diverticulitis - laparoscopic peritoneal lavage - perforated diverticulitis - purulent peritonitis


Publication History

Article published online:
24 February 2021

© 2021. Thieme. All rights reserved.

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