Operative management of diverticular emergencies

Strategies and outcomes

Wayne H Schwesinger, Carey P. Page, Harold V. Gaskill, Ronald M. Steward, Shailendra Chopra, William E. Strodel, Kenneth R Sirinek

Research output: Contribution to journalArticle

83 Citations (Scopus)

Abstract

Hypothesis: A selective surgical approach using either a 1- or a 2-stage resection is relatively safe and effective in the management of acute complicated colonic diverticulosis. Design: A consecutive cohort study. Setting: A university hospital. Patients: Eighty-nine consecutive patients who underwent emergency operations for diverticular disease between July 1, 1984, and June 30, 1999. There were 53 male and 36 female patients (mean age, 47 years). The ethnic background was predominantly Mexican American (58 patients [65.2%]). Interventions: Resections of the affected colon (n = 83) plus construction of a Hartmann pouch or mucous fistula (n = 72) or primary anastomosis (n = 11). Main Outcome Measures: Morbidity, mortality, and length of hospital stay. Results: Sixty-eight operations were performed for perforation at an annual rate that has increased greater than 75% in the past 15 years. Another 14 patients underwent operations for obstruction, and 7 underwent operations to control unremitting hemorrhage. Surgical therapy included resection of the affected segment of the bowel in 83 (93%) of the 89 patients, and a Hartmann pouch or mucous fistula was added in 72 (81%). A primary anastomosis was performed in 4 (80%) of 5 right-sided lesions but in only 7 (8%) of 84 left-sided lesions. Morbidity occurred in 38 (43%) of the 89 patients, and the mortality was 4%, with 4 deaths occurring secondary to sepsis in high-risk patients with perforations (n = 3) or obstructions (n = 1). The average length of hospital stay was 19.7 days (range, 5-80 days). Conclusions: Emergency operations for diverticular disease are uncommon but may be associated with substantial morbidity and occasional mortality. Complicated diverticulosis may present at a relatively young age, and perforated forms appear to be increasing rapidly in prevalence. Most diverticular lesions can be satisfactorily managed using a selective approach based on resection with either a primary anastomosis or a temporary colostomy.

Original languageEnglish (US)
Pages (from-to)558-563
Number of pages6
JournalArchives of Surgery
Volume135
Issue number5
StatePublished - May 2000

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Emergencies
Length of Stay
Morbidity
Fistula
Mortality
Colonic Diverticulosis
Colostomy
Diverticulum
Sepsis
Colon
Cohort Studies
Outcome Assessment (Health Care)
Hemorrhage

ASJC Scopus subject areas

  • Surgery

Cite this

Schwesinger, W. H., Page, C. P., Gaskill, H. V., Steward, R. M., Chopra, S., Strodel, W. E., & Sirinek, K. R. (2000). Operative management of diverticular emergencies: Strategies and outcomes. Archives of Surgery, 135(5), 558-563.

Operative management of diverticular emergencies : Strategies and outcomes. / Schwesinger, Wayne H; Page, Carey P.; Gaskill, Harold V.; Steward, Ronald M.; Chopra, Shailendra; Strodel, William E.; Sirinek, Kenneth R.

In: Archives of Surgery, Vol. 135, No. 5, 05.2000, p. 558-563.

Research output: Contribution to journalArticle

Schwesinger, WH, Page, CP, Gaskill, HV, Steward, RM, Chopra, S, Strodel, WE & Sirinek, KR 2000, 'Operative management of diverticular emergencies: Strategies and outcomes', Archives of Surgery, vol. 135, no. 5, pp. 558-563.
Schwesinger WH, Page CP, Gaskill HV, Steward RM, Chopra S, Strodel WE et al. Operative management of diverticular emergencies: Strategies and outcomes. Archives of Surgery. 2000 May;135(5):558-563.
Schwesinger, Wayne H ; Page, Carey P. ; Gaskill, Harold V. ; Steward, Ronald M. ; Chopra, Shailendra ; Strodel, William E. ; Sirinek, Kenneth R. / Operative management of diverticular emergencies : Strategies and outcomes. In: Archives of Surgery. 2000 ; Vol. 135, No. 5. pp. 558-563.
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title = "Operative management of diverticular emergencies: Strategies and outcomes",
abstract = "Hypothesis: A selective surgical approach using either a 1- or a 2-stage resection is relatively safe and effective in the management of acute complicated colonic diverticulosis. Design: A consecutive cohort study. Setting: A university hospital. Patients: Eighty-nine consecutive patients who underwent emergency operations for diverticular disease between July 1, 1984, and June 30, 1999. There were 53 male and 36 female patients (mean age, 47 years). The ethnic background was predominantly Mexican American (58 patients [65.2{\%}]). Interventions: Resections of the affected colon (n = 83) plus construction of a Hartmann pouch or mucous fistula (n = 72) or primary anastomosis (n = 11). Main Outcome Measures: Morbidity, mortality, and length of hospital stay. Results: Sixty-eight operations were performed for perforation at an annual rate that has increased greater than 75{\%} in the past 15 years. Another 14 patients underwent operations for obstruction, and 7 underwent operations to control unremitting hemorrhage. Surgical therapy included resection of the affected segment of the bowel in 83 (93{\%}) of the 89 patients, and a Hartmann pouch or mucous fistula was added in 72 (81{\%}). A primary anastomosis was performed in 4 (80{\%}) of 5 right-sided lesions but in only 7 (8{\%}) of 84 left-sided lesions. Morbidity occurred in 38 (43{\%}) of the 89 patients, and the mortality was 4{\%}, with 4 deaths occurring secondary to sepsis in high-risk patients with perforations (n = 3) or obstructions (n = 1). The average length of hospital stay was 19.7 days (range, 5-80 days). Conclusions: Emergency operations for diverticular disease are uncommon but may be associated with substantial morbidity and occasional mortality. Complicated diverticulosis may present at a relatively young age, and perforated forms appear to be increasing rapidly in prevalence. Most diverticular lesions can be satisfactorily managed using a selective approach based on resection with either a primary anastomosis or a temporary colostomy.",
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AU - Strodel, William E.

AU - Sirinek, Kenneth R

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N2 - Hypothesis: A selective surgical approach using either a 1- or a 2-stage resection is relatively safe and effective in the management of acute complicated colonic diverticulosis. Design: A consecutive cohort study. Setting: A university hospital. Patients: Eighty-nine consecutive patients who underwent emergency operations for diverticular disease between July 1, 1984, and June 30, 1999. There were 53 male and 36 female patients (mean age, 47 years). The ethnic background was predominantly Mexican American (58 patients [65.2%]). Interventions: Resections of the affected colon (n = 83) plus construction of a Hartmann pouch or mucous fistula (n = 72) or primary anastomosis (n = 11). Main Outcome Measures: Morbidity, mortality, and length of hospital stay. Results: Sixty-eight operations were performed for perforation at an annual rate that has increased greater than 75% in the past 15 years. Another 14 patients underwent operations for obstruction, and 7 underwent operations to control unremitting hemorrhage. Surgical therapy included resection of the affected segment of the bowel in 83 (93%) of the 89 patients, and a Hartmann pouch or mucous fistula was added in 72 (81%). A primary anastomosis was performed in 4 (80%) of 5 right-sided lesions but in only 7 (8%) of 84 left-sided lesions. Morbidity occurred in 38 (43%) of the 89 patients, and the mortality was 4%, with 4 deaths occurring secondary to sepsis in high-risk patients with perforations (n = 3) or obstructions (n = 1). The average length of hospital stay was 19.7 days (range, 5-80 days). Conclusions: Emergency operations for diverticular disease are uncommon but may be associated with substantial morbidity and occasional mortality. Complicated diverticulosis may present at a relatively young age, and perforated forms appear to be increasing rapidly in prevalence. Most diverticular lesions can be satisfactorily managed using a selective approach based on resection with either a primary anastomosis or a temporary colostomy.

AB - Hypothesis: A selective surgical approach using either a 1- or a 2-stage resection is relatively safe and effective in the management of acute complicated colonic diverticulosis. Design: A consecutive cohort study. Setting: A university hospital. Patients: Eighty-nine consecutive patients who underwent emergency operations for diverticular disease between July 1, 1984, and June 30, 1999. There were 53 male and 36 female patients (mean age, 47 years). The ethnic background was predominantly Mexican American (58 patients [65.2%]). Interventions: Resections of the affected colon (n = 83) plus construction of a Hartmann pouch or mucous fistula (n = 72) or primary anastomosis (n = 11). Main Outcome Measures: Morbidity, mortality, and length of hospital stay. Results: Sixty-eight operations were performed for perforation at an annual rate that has increased greater than 75% in the past 15 years. Another 14 patients underwent operations for obstruction, and 7 underwent operations to control unremitting hemorrhage. Surgical therapy included resection of the affected segment of the bowel in 83 (93%) of the 89 patients, and a Hartmann pouch or mucous fistula was added in 72 (81%). A primary anastomosis was performed in 4 (80%) of 5 right-sided lesions but in only 7 (8%) of 84 left-sided lesions. Morbidity occurred in 38 (43%) of the 89 patients, and the mortality was 4%, with 4 deaths occurring secondary to sepsis in high-risk patients with perforations (n = 3) or obstructions (n = 1). The average length of hospital stay was 19.7 days (range, 5-80 days). Conclusions: Emergency operations for diverticular disease are uncommon but may be associated with substantial morbidity and occasional mortality. Complicated diverticulosis may present at a relatively young age, and perforated forms appear to be increasing rapidly in prevalence. Most diverticular lesions can be satisfactorily managed using a selective approach based on resection with either a primary anastomosis or a temporary colostomy.

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