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Revista Mexicana de Coloproctología Enfermedades del Ano, Recto y Colon

2005, Number 1

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Rev Mex Coloproctol 2005; 11 (1)

Complicated Diverticular Diseases (Peritonitis)

Hequera JA, Avella G, Obregón GJ

Language: Spanish
References: 68
Page: 23-32
PDF size: 148.07 Kb.


ABSTRACT

The Diverticular disease of the colon, also called Diverticular colopathy or diverticulogena disease of the colon, it’s a very good defined affection, individualized by acquired invaginations of the colonic wall, denominated “diverticula.” Objective: A retrospective revision of the Diverticular peritonitis was made to analyze its terminology, acute symptoms, classification, types of tactical and surgical techniques, complications of these and my personal experience at all. Material and methods: A retrospective study of sixty four patients that were managed in the hospitals “Dupuytren”. From January 1994 to January 2004, with diagnostic of Diverticular peritonitis, 51 cases (79.6%) presented the purulent type and 13 (20.3%) the fecal type. The surgical tactics that we used at first was III and IV. According to the Hinchey classifications and cols. colostomy and drainage 3 cases in both types. The operation of Hartmann in 51 cases in the type III, 38 of these passed to the type IV, the operation of Lahey 5 cases in both types. The resection and anastomosis primary 5 cases in both types. Results: From the 64 patients, 41 (64.0%) their evolution was good, with the medical treatment and the surgical tactics practiced until the reconstruction with resection of the residual sigmoid, 16 patients (25%) presented complications; 9 with wall abscess, 3 cases with persistent ileo, evisceration 1 case, pneumonia 1 case, infection urinary 1 case and TVP 1 case. There were 7 deaths for persistent sepsis. Discussion: The Diverticular peritonitis is the most frequent complication, when they have preceded several diverticulitis episodes, both types (purulent and fecal) if they are not managed with a good outline of medical treatment and surgical tactics-dexterity it might increase the rate of mortality. Conclusion: All the derivative procedures or colostomies, drainages, resections and reconstructions in the urgency or elective stages should be very support. The operation of Hartmann in my casuistry was the most practiced. The resection and primary anastomoses should be done in very selective cases.


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