Perforated Diverticulitis with Generalized Peritonitis: Low Stoma Rate Using a “Damage Control Strategy”

• Published in: World journal of surgery 2018-10, Vol.42 (10), p.3189-3195
• Main Authors: Sohn, Maximilian, Iesalnieks, I., Agha, A., Steiner, P., Hochrein, A., Pratschke, J., Ritschl, P., Aigner, F.
• Format: Article
• Language: English
• Subjects: Abdominal Surgery; Adult; Aged; Aged, 80 and over; Anastomosis; Anastomosis, Surgical - adverse effects; Cardiac Surgery; Colon; Colon, Sigmoid - surgery; Colonic Diseases; Colostomy - adverse effects; Complications; Damage assessment; Diverticulitis, Colonic - complications; Diverticulitis, Colonic - etiology; Emergency procedures; Female; General Surgery; Humans; Ileostomy; Intestinal Perforation - etiology; Length of Stay; Male; Medicine; Medicine & Public Health; Middle Aged; Original Scientific Report; Ostomy; Patients; Peritonitis; Peritonitis - etiology; Retrospective Studies; Shock, Septic - complications; Shock, Septic - etiology; Strategy; Surgery; Surgical Stomas - statistics & numerical data; Thoracic Surgery; Treatment Outcome; Vascular Surgery
• ISSN: 0364-2313; 1432-2323
• DOI: 10.1007/s00268-018-4585-y

Purpose Optimal surgical management of perforated diverticulitis of the sigmoid colon has yet to be clearly defined. The purpose of this study was to evaluate efficacy of a “Damage Control Strategy” (DCS). Materials and methods Patients with perforated diverticulitis of the sigmoid colon complicated by generalized peritonitis (Hinchey III and IV) surgically treated according to a damage control strategy between May 2011 and February 2017 were enrolled in the present multicenter retrospective cohort study. Data were collected at three surgical centers. DCS comprises a two-stage concept: [ 1 ] limited resection of the perforated colon segment with oral and aboral blind closure during the emergency procedure and [ 2 ] definitive reconstruction at scheduled second laparotomy (anastomosis ∓ loop ileostomy or a Hartmann’s procedure) after 24–48 h. Results Fifty-eight patients were included into the analysis [W:M 28:30, median age 70.1 years (30–92)]. Eleven patients (19%) initially presented with fecal peritonitis (Hinchey IV) and 47 patients with purulent peritonitis (Hinchey III). An anastomosis could be created during the second procedure in 48 patients (83%), 14 of those received an additional loop ileostomy. In the remaining ten patients ( n  = 17%), an end colostomy was created at second laparotomy. A fecal diversion was performed in five patients to treat anastomotic complications. Thus, altogether, 29 patients (50%) had stoma at the end of the hospital stay. The postoperative mortality was 9% ( n  = 5), and median postoperative hospital stay was 18.5 days (3–66). At the end of the follow-up, 44 of 53 surviving patients were stoma free (83%). Conclusion The use of the Damage Control strategy leads to a comparatively low stoma rate in patients suffering from perforated diverticulitis with generalized peritonitis.