MALATTIA DIVERTICOLARE DEL COLON COMPLICATA DA PERFORAZIONE

The authors present 50 cases of perforated diverticular disease of the colon admitted and operated as an emergency at the Surgical Departments of the Casalpusterlengo (MI) and Piacenza Hospitals over 10 years (1982-1992). The patients were 66% male and 34% female with a mean age of 71 years-old. The perforations were mostly located in the sigmoid (96%) and the stage were: pericoloc abscess (stage I) 18070; pelvic abscess (stage II) 32%; purulent peritonitis (stage III) 26%; fecal peritonitis (stage TV) 24%. Hartmann procedure was carried out in 70% and resection with primary anastomosis in 24%. Restoration of bowel continuity was done in 80%. Overall morbidity was 26% (respiratory insufficiency 4; renal insufficiency 2; wound infection 6; anastomotic leak 2; pulmonary embolism 1; hemorrhagic shock 1; sepsis 3; post-incisional hernia 6) all after the first operation. Mortality was 10% (pulmonary embolism 1; sepsis 3; renal insufficiency 1). In the I and II stages the resection with primary anastomosis is the best surgical choice; the Hartmann procedure in the III and IV stages as well. The 3 stage procedure cannot represent anymore a rational surgical option ulness in some cases. Early diagnosis and good surgical judgement and management are the successfull factors in the care of those patients.