Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
World Journal of Surgery
Published in: World Journal of Surgery 3/2010

Open Access 01-03-2010

Treatment of Perforated Diverticulitis with Generalized Peritonitis: Past, Present, and Future

Authors: Jefrey Vermeulen, Johan F. Lange

Published in: World Journal of Surgery | Issue 3/2010

Login to get access

Abstract

Background

The supposed optimal treatment of perforated diverticulitis with generalized peritonitis has changed several times during the last century, but at present is still unclear.

Methods/results

The first cases of complicated perforated diverticulitis of the colon were reported in the beginning of the twentieth century. At that time the first therapeutic guidelines were postulated in which an initial nonresectional procedure was provided to be the safest plan of management. After many years in which resection had become standard practice, today, one century later, again (laparoscopic) nonresectional surgery is presented as a safe and promising alternative in treatment of complicated perforated diverticulitis. The question rises what had happened to close the circle?

Conclusions

This paper includes a historic summary of changing patterns in surgical strategies in perforated diverticulitis complicated by generalized peritonitis.
Literature
1.
Vermeulen J, Gosselink MP, Hop WCJ, Lange JF, Coene PPLO, van der Harst E, Weidema WF, Mannaerts GHH (2009) Hospital mortality after emergency surgery for perforated diverticulitis. Ned Tijdschr Geneesk 153:1209–1214
2.
Parks TG (1975) Natural history of diverticular disease of the colon. Clin Gastroenterol 4:53–69PubMed
3.
Hart A, Kennedy J, Stebbings W (2000) How frequently do large bowel diverticular perforate? An incidence and cross-sectional study. Eur J Gastroenterol Hepatol 12:661–666CrossRefPubMed
4.
Morris CR, Harvey IM, Stebbings WS, Hart AR (2008) Incidence of perforated diverticulitis and risk factors for death in a UK population. Br J Surg 95:876–881CrossRefPubMed
5.
Salem L, Flum DR (2004) Primary anastomosis or Hartmann’s procedure for patients with diverticular peritonitis? A systematic review. Dis Colon Rectum 47:1953–1964CrossRefPubMed
6.
Constantinides VA, Tekkis PP, Senapati A (2006) Association of Coloproctology of Great Britain Ireland. Prospective multicentre evaluation of adverse outcomes following treatment for complicated diverticular disease. Br J Surg 93:1503–1513CrossRefPubMed
7.
Schilling MK, Maurer CA, Kollmar O, Buchler MW (2001) 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 44:699–703CrossRefPubMed
8.
Hoemke M, Treckmann J, Schmitz R, Shah S (1999) Complicated diverticulitis of the sigmoid: a prospective study concerning primary resection with secure primary anastomosis. Dig Surg 16:420–424CrossRefPubMed
9.
Myers E, Hurley M, O’Sullivan GC, Kavanagh D, Wilson I, Winter DC (2008) Laparoscopic peritoneal lavage for generalized peritonitis due to perforated diverticulitis. Br J Surg 95:97–101CrossRefPubMed
10.
Franklin ME Jr, Portillo G, Treviño JM, Gonzalez JJ, Glass JL (2008) Long-term experience with the laparoscopic approach to perforated diverticulitis plus generalized peritonitis. World J Surg 32:1507–1511CrossRefPubMed
11.
Bretagnol F, Pautrat K, Mor C, Benchellal Z, Huten N, de Calan L (2008) Emergency laparoscopic management of perforated sigmoid diverticulitis: a promising alternative to more radical procedures. J Am Coll Surg 206:654–657CrossRefPubMed
12.
Mayo WJ, Wilson LB, Griffin HZ (1907) Acquired diverticulitis of the large intestine. Surg Gynecol Obstet 5:8–15
13.
14.
Lockhart-Mummery JP (1938) Late results of diverticulitis. Lancet 2:1401–1404CrossRef
15.
Smithwick RH (1942) Experiences with the surgical management of diverticulitis of the sigmoid. Ann Surg 115:969–983CrossRefPubMed
16.
Florey HW (1945) Use of micro-organisms for therapeutic purposes. Br Med J 2:635–642CrossRef
17.
18.
Miller DW, Wichern WA (1971) Perforated sigmoid diverticulitis. Appraisal of primary versus delayed resection. Am J Surg 121:536–540CrossRefPubMed
19.
Classen JN, Bonardi R, O’Mara CS, Finney DC, Sterioff S (1976) Surgical treatment of acute diverticulitis by staged procedures. Ann Surg 184:582–586CrossRefPubMed
20.
Smiley DF (1966) Perforated sigmoid diverticulitis with spreading peritonitis. Am J Surg 111:431–435CrossRefPubMed
21.
22.
Eng K, Ranson JCH, Localio SA (1977) Resection of the perforated segment. A significant advance in treatment of diverticulitis with free perforation or abscess. Am J Surg 133:67–72CrossRefPubMed
23.
Jacobson MA, Young LS (1986) New developments in the treatment of Gram-negative bacteremia. West J Med 144:185–194PubMed
24.
Painter NS, Burkitt DP (1963) Intrasigmoid pressures in diverticulosis of the colon. Br Med J 2:309CrossRef
25.
Auguste L, Borrero E, Wise L (1985) Surgical management of perforated colonic diverticulitis. Arch Surg 120:450–452PubMed
26.
Hartmann H (1923) Note sur un procédé nouveau d’extirpation des cancers de la partie terminale due côlon. Bull Mém Soc Chir Paris 1474-1477
27.
Krukowski ZH, Matheson NA (1984) Emergency surgery for diverticular disease complicated by generalized and faecal peritonitis: a review. Br J Surg 71:921–927CrossRefPubMed
28.
Greif JM, Fried G, McSherry CK (1980) Surgical treatment of perforated diverticulitis of the sigmoid colon. Dis Colon Rectum 23:483–487CrossRefPubMed
29.
Kronborg O (1993) Treatment of perforated sigmoid diverticulitis: a prospective randomized trial. Br J Surg 80:505–507CrossRefPubMed
30.
Zeitoun G, Laurent A, Rouffet F, Hay JM, Fingerhut A, Paquet JC, Peillons C, Research TF (2000) Multicentre, randomized clinical trial of primary versus secondary sigmoid resection in generalised peritonitis complicating sigmoid diverticulitis. Br J Surg 87:1366–1374CrossRefPubMed
31.
Wong WD, Wexner SD, Lowry A, Vernava A III, Burnstein M, Denstman F, Fazio V, Kerner B, Moore R, Oliver G, Peters W, Ross T, Senatore P, Simmang C (2000) Practice parameters for the treatment of sigmoid diverticulitis–supporting documentation. The Standards Task Force. The American Society of Colon and Rectal Surgeons. Dis Colon Rectum 43:290–297CrossRefPubMed
32.
Wilson RF (1985) Special problems in the diagnosis and treatment of surgical sepsis. Surg Clin North Am 64:965–989
33.
Peoples JB, Vilk D, Maguire JP, Elliott DW (1990) Reassessment of primary resection of the perforated segment for severe colonic diverticulitis. Am J Surg 159:291–293CrossRefPubMed
34.
Gooszen AW, Tollenaar RA, Geelkerken RH, Smeets HJ, Bemelman WA, Van Schaardenburgh P et al (2001) Prospective study of primary anastomosis following sigmoid resection for suspected acute complicated diverticular disease. Br J Surg 88:693–697CrossRefPubMed
35.
Richter S, Lindemann W, Kollmar O, Pistorius GA, Maurer CA, Schilling MK (2006) One stage sigmoid colon resection for perforated diverticulitis (Hinchey stages III and IV). World J Surg 30:1027–1032CrossRefPubMed
36.
Medina VA, Papanicolaou GK, Tadros RR, Fielding LP (1991) Acute perforated diverticulitis: primary resection and anastomosis? Conn Med 55:258–261PubMed
37.
Maggard MA, Zingmond D, O’Connell JB, Ko CY (2004) What proportion of patients with an ostomy (for diverticulitis) gets reversed? Am Surg 70:928–931PubMed
38.
Vermeulen J, Coene PP, Van Hout NM, van der Harst E, Gosselink MP, Mannaerts GH, Weidema WF, Lange JF (2009) Restoration of bowel continuity after surgery for acute perforated diverticulitis. Should Hartmann’s procedure be considered a one-stage procedure? Colorectal Dis 11:619–624CrossRefPubMed
39.
Banerjee S, Leather AJM, Rennie JA, Samano N, Gonzalez JG, Papagrigoriadis S (2005) Feasibility and morbidity of reversal of Hartmann’s. Colorectal Dis 7:454–459CrossRefPubMed
40.
Nugent KP, Daniels P, Stewart B, Patankar R, Johnson CD (1999) Quality of life in stoma patients. Dis Colon Rectum 42(12):1569–1574CrossRefPubMed
41.
Gooszen AW, Geelkerken RH, Hermans J, Lagaay MB, Gooszen HG (2000) Quality of life with a temporary stoma: ileostomy vs. colostomy. Dis Colon Rectum 43:650–655CrossRefPubMed
42.
Bell C, Asolati M, Hamilton E, Fleming J, Nwariaku F, Sarosi G, Anthony T (2005) A comparison of complications associated with colostomy reversal versus ileostomy reversal. Am J Surg 190:717–720CrossRefPubMed
43.
Gastinger I, Marusch F, Steinert R, Wolff S, Koeckerling F, Lippert H (2005) Working Group “Colon/Rectum Carcinoma”. Protective defunctioning stoma in low anterior resection for rectal carcinoma. Br J Surg 92:1137–1142CrossRefPubMed
44.
Matthiessen P, Hallböök O, Rutegård J, Simert G, Sjödahl R (2007) Defunctioning stoma reduces symptomatic anastomotic leakage after low anterior resection of the rectum for cancer: a randomized multicenter trial. Ann Surg 246:207–214CrossRefPubMed
45.
Kressner U, Antonsson J, Ejerblad S, Gerdin B, Påhlman L (1994) Intraoperative colonic lavage and primary anastomosis—an alternative to Hartmann procedure in emergency surgery of the left colon. Eur J Surg 160:287–292PubMed
46.
Regenet N, Pessaux P, Hennekinne S, Lermite E, Tuech JJ, Brehant O, Arnaud JP (2003) Primary anastomosis after intraoperative colonic lavage vs. Hartmann’s procedure in generalized peritonitis complicating diverticular disease of the colon. Int J Colorectal Dis 18:503–507CrossRefPubMed
47.
Makela J, Kiviniemi H, Laitinen S (2005) Prognostic factors of perforated sigmoid diverticulitis in the elderly. Dig Surg 22:100–106CrossRefPubMed
48.
Pisanu A, Cois A, Uccheddu A (2004) Surgical treatment of perforated diverticular disease: evaluation of factors predicting prognosis in the elderly. Int Surg 89:35–38PubMed
49.
Oomen JTL, Engel AF, Cuesta MA (2005) Mortality after acute surgery for complications of diverticular disease of the sigmoid colon is almost exclusively due to patient related factors. Colorectal Dis 8:112–119CrossRef
50.
Abbas S (2007) Resection and primary anastomosis in acute complicated diverticulitis, a systematic review of the literature. Int J Colorectal Dis 22:351–357CrossRefPubMed
51.
Zdichavsky M, Granderath FA, Blumenstock G, Kramer M, Küper MA, Königsrainer A (2009) Acute laparoscopic intervention for diverticular disease (AIDD): a feasible approach. Langenbecks Arch Surg Surg 19:1143–1149
52.
Agaba EA, Zaidi RM, Ramzy P, Aftab M, Rubach E, Gecelter G, Ravikumar TS, Denoto G (2009) Laparoscopic Hartmann’s procedure: a viable option for treatment of acutely perforated diverticulitis. Surg Endosc 23:1483–1486CrossRefPubMed
53.
Faranda C, Barrat C, Catheline JM, Champault GG (2000) Two-stage laparoscopic management of generalized peritonitis due to perforated sigmoid diverticula: eighteen cases. Surg Laparosc Endosc Percutan Tech 10:135–138PubMed
54.
Taylor CJ, Layani L, Ghusn MA, White SI (2006) Perforated diverticulitis managed by laparoscopic lavage. ANZ J Surg 76(11):962–965CrossRefPubMed
55.
Karoui M, Champault A, Pautrat K, Valleur P, Cherqui D, Champault G (2009) Laparoscopic peritoneal lavage or primary anastomosis with defunctioning stoma for Hinchey 3 complicated diverticulitis: results of a comparative study. Dis Colon Rectum 52:609–615PubMed
56.
Favuzza J, Friel JC, Kelly JJ, Perugini R, Counihan TC (2009) Benefits of laparoscopic peritoneal lavage for complicated sigmoid diverticulitis. Int J Colorectal Dis 24:797–801CrossRefPubMed
57.
Sauerland S, Agresta F, Bergamaschi R, Borzellino G, Budzynski A, Champault G, Fingerhut A, Isla A, Johansson M, Lundorff P, Navez B, Saad S, Neugebauer EA (2006) Laparoscopy for abdominal emergencies: evidence-based guidelines of the European Association for Endoscopic Surgery. Surg Endosc 20:14–29CrossRefPubMed
58.
Santaniello M, Bergamaschi R (2006) Perforated diverticulitis: should the method of surgical access to the abdomen determine treatment? Colorectal Dis 9:494–495CrossRef
59.
Essani R, Bergamaschi R (2009) Laparoscopic peritoneal lavage for generalized peritonitis due to perforated diverticulitis. Br J Surg 96:118CrossRefPubMed
60.
O’Sullivan GC, Murphy D, O’Brien MG, Ireland A (1996) Laparoscopic management of generalised peritonitis due to perforated colonic diverticula. Am J Surg 171:432–434CrossRefPubMed
61.
Polk HC Jr (1979) Generalized peritonitis: a continuing challenge. Surgery 86:777–778PubMed
62.
Cheadle WG, David A, Spain DA (2003) The continuing challenge of intra-abdominal infection. Am J Surg 186:15–22CrossRef
63.
Lohrmann C, Ghanem N, Pache G, Makowiec F, Kotter E, Langer M (2005) CT in acute perforated sigmoid diverticulitis. Eur J Radiol 56:78–83CrossRefPubMed
64.
Stijn Blot S, De Waele JJ (2005) Critical issues in the clinical management of complicated intra-abdominal infections [review]. Drugs 65:1611–1620CrossRefPubMed
65.
Soumian S, Thomas S, Mohan PP, Khan N, Khan Z, Raju T (2008) Management of Hinchey II diverticulitis. World J Gastroenterol 14:7163–7169CrossRefPubMed
66.
Men S, Akhan O, Köroglu M (2002) Percutaneous drainage of abdominal abscess. Eur J Radiol 43:204–218CrossRefPubMed
Metadata
Title
Treatment of Perforated Diverticulitis with Generalized Peritonitis: Past, Present, and Future
Authors
Jefrey Vermeulen
Johan F. Lange
Publication date
01-03-2010
Publisher
Springer-Verlag
Published in
World Journal of Surgery / Issue 3/2010
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI
https://doi.org/10.1007/s00268-009-0372-0

Other articles of this Issue 3/2010

World Journal of Surgery 3/2010 Go to the issue

OriginalPaper

Cleft Lip and Palate as a Cost-effective Health Care Treatment in the Developing World

OriginalPaper

Seven Sins of Humanitarian Medicine

OriginalPaper

Role of Collaborative Academic Partnerships in Surgical Training, Education, and Provision

OriginalPaper

Structured Ultrasonography Workshop for Breast Surgeons: Is It An Effective Training Tool?

OriginalPaper

Emergency and Essential Surgical Services in Afghanistan: Still a Missing Challenge

OriginalPaper

Developing Priorities for Addressing Surgical Conditions Globally: Furthering the Link Between Surgery and Public Health Policy