Emergency Management of Diverticulitis

Diverticulitis is a common problem, and although most cases will respond to conservative measures, surgeons will frequently need to treat patients requiring emergency surgery. Surgical management has progressed over the past 30 years, with a change in practice from routine drainage and proximal diversion (necessitating two further major procedures) to primary resection and anastomosis in selected cases. In 2004, surgeons must use clinical judgment to determine which approach will optimize outcomes both in terms of morbidity and mortality and in terms of quality of life for their patients.

KEYWORDS

Diverticulitis - surgical management - emergency

REFERENCES

• 1 Sandler R S, Everhart J E, Donowitz M et al.. The burden of selected digestive diseases in the United States.  Gastroenterology. 2002;  122 1500-1511
• 2 Kang J Y, Hoare J, Tinto A et al.. Diverticular disease of the colon-on the rise: a study of hospital admissions in England between 1989/1990 and 1999/2000.  Aliment Pharmacol Ther. 2003;  17 1189-1195
• 3 Makela J, Kiviniemi H, Laitinen S. Prevalence of perforated sigmoid diverticulitis is increasing.  Dis Colon Rectum. 2002;  45 955-961
• 4 Hart A R, Kennedy H J, Stebbings W S, Day N E. How frequently do large bowel diverticula perforate? An incidence and cross-sectional study.  Eur J Gastroenterol Hepatol. 2000;  12 661-665
• 5 Chan C C, Lo K K, Chung E C, Lo S S, Hon T Y. Colonic diverticulosis in Hong Kong distribution pattern and clinical significance.  Clin Radiol. 1998;  53 842-844
• 6 Miura S, Kodaira S, Shatari T, Nishioka M, Hosoda Y, Hisa T K. Recent trends in diverticulosis of the right colon in Japan retrospective review in a regional hospital.  Dis Colon Rectum. 2000;  43 1383-1389
• 7 Nakaji S, Danjo K, Munakata A et al.. Comparison of etiology of right-sided diverticula in Japan with that of left-sided diverticula in the West.  Int J Colorectal Dis. 2002;  17 365-373
• 8 Nakada I, Ubukata H, Goto Y et al.. Diverticular disease of the colon at a regional general hospital in Japan.  Dis Colon Rectum. 1995;  38 755-759
• 9 Lane J S, Sarkar R, Schmit P J, Chandler C F, Thompson Jr J E. Surgical approach to cecal diverticulitis.  J Am Coll Surg. 1999;  188 629-634
• 10 Shyung L R, Lin S C, Shih S C, Kao C R, Chou S Y. Decision making in right-sided diverticulitis.  World J Gastroenterol. 2003;  9 606-608
• 11 Lo C Y, Chu K W. Acute diverticulitis of the right colon.  Am J Surg. 1996;  171 244-246
• 12 Fang J F, Chen R J, Lin B C, Hsu Y B, Kao J L, Chen M F. Aggressive resection is indicated for cecal diverticulitis.  Am J Surg. 2003;  185 135-140
• 13 Law W L, Lo C Y, Chu K W. Emergency surgery for colonic diverticulitis differences between right-sided and left-sided lesions.  Int J Colorectal Dis. 2001;  16 280-284
• 14 Ngoi S S, Chia J, Goh M Y, Sim E, Rauff A. Surgical management of right colon diverticulitis.  Dis Colon Rectum. 1992;  35 799-802
• 15 Harada R N, Whelan Jr T J. Surgical management of cecal diverticulitis.  Am J Surg. 1993;  166 666-669
• 16 Graham S M, Ballantyne G H. Cecal diverticulitis. A review of the American experience.  Dis Colon Rectum. 1987;  30 821-826
• 17 Sarkar R, Bennion R S, Schmit P J, Thompson J E. Emergent ileocecectomy for infection and inflammation.  Am Surg. 1997;  63 874-877
• 18 Oudenhoven L F, Koumans R K, Puylaert J B. Right colonic diverticulitis: US and CT findings-new insights about frequency and natural history.  Radiology. 1998;  208 611-618
• 19 Komuta K, Yamanaka S, Okada K et al.. Toward therapeutic guidelines for patients with acute right-sided diverticulitis.  Am J Surg. 2004;  187 233-237
• 20 Stollman N, Raskin J B. Diverticular disease of the colon.  Lancet. 2004;  363 631-639
• 21 Hinchey E J, Schaal P G, Richards G K. Treatment of perforated diverticular disease of the colon.  Adv Surg. 1978;  12 85-109
• 22 Classen J N, Bonardi R, O'Mara C S, Finney D C, Sterioff S. Surgical treatment of acute diverticulitis by staged procedures.  Ann Surg. 1976;  184 582-586
• 23 Krukowski Z H, Matheson N A. Emergency surgery for diverticular disease complicated by generalized and faecal peritonitis: a review.  Br J Surg. 1984;  71 921-927
• 24 Wara P, Sorensen K, Berg V, Amdrup E. The outcome of staged management of complicated diverticular disease of the sigmoid colon.  Acta Chir Scand. 1981;  147 209-214
• 25 Himal H S, Ashby D B, Duignan J P, Richardson D M, Miller J L, MacLean L D. Management of perforating diverticulitis of the colon.  Surg Gynecol Obstet. 1977;  144 225-226
• 26 Nagorney D M, Adson M A, Pemberton J H. Sigmoid diverticulitis with perforation and generalized peritonitis.  Dis Colon Rectum. 1985;  28 71-75
• 27 Zeitoun G, Laurent A, Rouffet F et al.. Multicentre, randomized clinical trial of primary versus secondary sigmoid resection in generalized peritonitis complicating sigmoid diverticulitis.  Br J Surg. 2000;  87 1366-1374
• 28 Abcarian H, Pearl R K. A safe technique for resection of perforated sigmoid diverticulitis.  Dis Colon Rectum. 1990;  33 905-906
• 29 Goyal A, Schein M. Current practices in left-sided colonic emergencies: a survey of US gastrointestinal surgeons.  Dig Surg. 2001;  18 399-402
• 30 Belmonte C, Klas J V, Perez J J et al.. The Hartmann procedure. First choice or last resort in diverticular disease?.  Arch Surg. 1996;  131 612-615
• 31 Finlay I G, Carter D C. A comparison of emergency resection and staged management in perforated diverticular disease.  Dis Colon Rectum. 1987;  30 929-933
• 32 Alanis A, Papanicolaou G K, Tadros R R, Fielding L P. Primary resection and anastomosis for treatment of acute diverticulitis.  Dis Colon Rectum. 1989;  32 933-939
• 33 Silva M A, Ratnayake G, Deen K I. Quality of life of stoma patients: temporary ileostomy versus colostomy.  World J Surg. 2003;  27 421-424
• 34 Gooszen A W, Geelkerken R H, Hermans J, Lagaay M B, Gooszen H G. Quality of life with a temporary stoma: ileostomy vs. colostomy.  Dis Colon Rectum. 2000;  43 650-655
• 35 Gregg R O. The place of emergency resection in the management of obstructing and perforating lesions of the colon.  Surgery. 1955;  27 754-761
• 36 Rothenberger D A, Garcia-Aguilar J. Diverticular disease of the colon. In: Cameron JL Current Surgical Therapy St Louis, MO; Mosby Inc 1998: 173-179
• 37 Guenaga K F, Matos D, Castro A A, Atallah A N, Wille-Jorgensen P. Mechanical bowel preparation for elective colorectal surgery.  Cochrane Database Syst Rev. 2003;  CD001544
• 38 Gooszen A W, Geelkerken R H, Hermans J, Lagaay M B, Gooszen H G. Temporary decompression after colorectal surgery: randomized comparison of loop ileostomy and loop colostomy.  Br J Surg. 1998;  85 76-79
• 39 Williams N S, Nasmyth D G, Jones D, Smith A H. De-functioning stomas: a prospective controlled trial comparing loop ileostomy with loop transverse colostomy.  Br J Surg. 1986;  73 566-570
• 40 Edwards D P, Leppington-Clarke A, Sexton R, Heald R J, Moran B J. Stoma-related complications are more frequent after transverse colostomy than loop ileostomy: a prospective randomized clinical trial.  Br J Surg. 2001;  88 360-363
• 41 Sakai Y, Nelson H, Larson D, Maidl L, Young-Fadok T, Ilstrup D. Temporary transverse colostomy vs loop ileostomy in diversion a case-matched study.  Arch Surg. 2001;  136 338-342
• 42 Rullier E, Le Toux N, Laurent C, Garrelon J L, Parneix M, Saric J. Loop ileostomy versus loop colostomy for defunctioning low anastomoses during rectal cancer surgery.  World J Surg. 2001;  25 274-277
• 43 Tang C L, Seow-Choen F, Fook-Chong S, Eu K W. Bioresorbable adhesion barrier facilitates early closure of the defunctioning ileostomy after rectal excision: a prospective, randomized trial.  Dis Colon Rectum. 2003;  46 1200-1207
• 44 Zorcolo L, Covotta L, Carlomagno N, Bartolo D C. Safety of primary anastomosis in emergency colo-rectal surgery.  Colorectal Dis. 2003;  5 262-269
• 45 Regenet N, Pessaux P, Hennekinne S et al.. Primary anastomosis after intraoperative colonic lavage vs. Hartmann’s procedure in generalized peritonitis complicating diverticular disease of the colon.  Int J Colorectal Dis. 2003;  18 503-507
• 46 Biondo S, Jaurrieta E, Jorba R et al.. Intraoperative colonic lavage and primary anastomosis in peritonitis and obstruction.  Br J Surg. 1997;  84 222-225
• 47 Schilling M K, Maurer C A, Kollmar O, Buchler M W. Primary vs. secondary anastomosis after sigmoid colon resection for perforated diverticulitis (Hinchey Stage III and IV): a prospective outcome and cost analysis.  Dis Colon Rectum. 2001;  44 699-703
• 48 Schwandner O, Farke S, Fischer F, Eckmann C, Schiedeck T H, Bruch H P. Laparoscopic colectomy for recurrent and complicated diverticulitis: a prospective study of 396 patients.  Langenbecks Arch Surg. 2004;  389 97-103
• 49 Trebuchet G, Lechaux D, Lecalve J L. Laparoscopic left colon resection for diverticular disease.  Surg Endosc. 2002;  16 18-21
• 50 Guller U, Jain N, Hervey S, Purves H, Pietrobon R. Laparoscopic vs open colectomy: outcomes comparison based on large nationwide databases.  Arch Surg. 2003;  138 1179-1186
• 51 Le Moine M C, Fabre J M, Vacher C, Navarro F, Picot M C, Domergue J. Factors and consequences of conversion in laparoscopic sigmoidectomy for diverticular disease.  Br J Surg. 2003;  90 232-236
• 52 Kockerling F, Schneider C, Reymond M A et al.. Laparoscopic resection of sigmoid diverticulitis. Results of a multicenter study. Laparoscopic Colorectal Surgery Study Group.  Surg Endosc. 1999;  13 567-571
• 53 Vargas H D, Ramirez R T, Hoffman G C et al.. Defining the role of laparoscopic-assisted sigmoid colectomy for diverticulitis.  Dis Colon Rectum. 2000;  43 1726-1731