Deferred elective colonic resection in complicated acute diverticulitis

• Published in: Chirurgia italiana Vol. 55; no. 2; p. 153
• Main Authors: Piardi, Tullio, Ferrari Bravo, Andrea, Giampaoli, Francesca, Porro, Matteo, Azzini, Carlo, Faidiga, Maria Cristina, Pouchè, Antonio
• Format: Journal Article
• Language: Italian
• Published: Italy 01-03-2003
• Subjects: Acute Disease; Adult; Aged; Aged, 80 and over; Colectomy - methods; Colonic Diseases - complications; Colonic Diseases - surgery; Diverticulitis - complications; Diverticulitis - surgery; Elective Surgical Procedures; Female; Humans; Male; Middle Aged; Time Factors; Treatment Outcome
• ISSN: 0009-4773

Twenty-three patients with acute diverticulitis complicated by pericolic or paracolic abscesses (Hinchey stage I-II) after a first phase of medical treatment were treated with deferred elective resection of the descending colon and sigmoid plus colorectal anastomosis performed on average 30 days after the onset of the acute episode. The pathologist's investigation of the surgical specimens demonstrated persistence of severe inflammatory lesions despite the apparently satisfactory clinical outcome. These data explain the frequent recurrences and indicate surgical treatment as being the only therapy capable of definitively resolving the condition. As compared with the emergency surgery performed by others, deferred elective resection makes it possible to operate on patients who, once the acute phase has been overcome, can have their hydroelectrolytic balance perfectly restored and be adequately monitored with treatment of associated diseases and perfect colon preparation. This strategy has allowed us to eliminate operative mortality and reduce the postoperative morbidity, both of which are significantly present in emergency surgical operations. Also the overall hospital stay in the two admissions, the interval between which can be reduced in ideal cases, does not significantly differ from that reported for emergency operations.