BACKGROUND: The traditional therapy for perforated sigmoid diverticulitis with peritonitis is emergency colectomy usually with colostomy. We report laparoscopic exploration with peritoneal lavage as an alternative in seven patients who required emergency surgery for diverticulitis. METHODS: Six patients presented with diffuse peritonitis and one with a failure of percutaneous therapy. All patients were explored laparoscopically and the peritoneal cavity was lavaged with saline in addition to receiving intravenous antibiotics. Patient demographics, clinical response, length of stay, and complications were recorded. RESULTS: Six patients had resolution of peritonitis resolved and patients were discharged from the hospital. One of these patients who developed a pelvic abscess required a percutaneous drainage postoperatively. This patient ultimately returned 3 months later with recurrent symptoms and underwent colectomy with primary anastomosis. One patient failed to improve initially and underwent colectomy with primary anastomosis on the same admission. Five patients subsequently had elective sigmoid resections, four laparoscopic and one open. Mean length of stay was 7.7 days. There was no mortality. CONCLUSION: We conclude that laparoscopic exploration and peritoneal lavage can be performed safely in patients with diffuse, purulent peritonitis. Using this approach, most patients with purulent peritonitis can avoid emergent laparotomy with the risk of colostomy, and the need for a second surgery.
BACKGROUND: The traditional therapy for perforated sigmoid diverticulitis with peritonitis is emergency colectomy usually with colostomy. We report laparoscopic exploration with peritoneal lavage as an alternative in seven patients who required emergency surgery for diverticulitis. METHODS: Six patients presented with diffuse peritonitis and one with a failure of percutaneous therapy. All patients were explored laparoscopically and the peritoneal cavity was lavaged with saline in addition to receiving intravenous antibiotics. Patient demographics, clinical response, length of stay, and complications were recorded. RESULTS: Six patients had resolution of peritonitis resolved and patients were discharged from the hospital. One of these patients who developed a pelvic abscess required a percutaneous drainage postoperatively. This patient ultimately returned 3 months later with recurrent symptoms and underwent colectomy with primary anastomosis. One patient failed to improve initially and underwent colectomy with primary anastomosis on the same admission. Five patients subsequently had elective sigmoid resections, four laparoscopic and one open. Mean length of stay was 7.7 days. There was no mortality. CONCLUSION: We conclude that laparoscopic exploration and peritoneal lavage can be performed safely in patients with diffuse, purulent peritonitis. Using this approach, most patients with purulent peritonitis can avoid emergent laparotomy with the risk of colostomy, and the need for a second surgery.
Authors: Bastiaan R Klarenbeek; Alexander A F A Veenhof; Elly S M de Lange; Willem A Bemelman; Roberto Bergamaschi; Piet Heres; Antonio M Lacy; Wim T van den Broek; Donald L van der Peet; Miguel A Cuesta Journal: BMC Surg Date: 2007-08-03 Impact factor: 2.102
Authors: Alexander Perathoner; Alexander Klaus; Gilbert Mühlmann; Michael Oberwalder; Raimund Margreiter; Reinhold Kafka-Ritsch Journal: Int J Colorectal Dis Date: 2010-02-11 Impact factor: 2.571
Authors: Manish Chand; Muhammed R S Siddiqui; Ashish Gupta; Shahnawaz Rasheed; Paris Tekkis; Amjad Parvaiz; Alex H Mirnezami; Tahseen Qureshi Journal: World J Gastroenterol Date: 2014-12-07 Impact factor: 5.742