Hartmann resection for perforated sigmoid diverticulitis. A retrospective study of the Vancouver General Hospital experience.

The results of management of perforated sigmoid diverticulitis were studied retrospectively at Vancouver General Hospital over a 15-year period. The Hartmann resection (or a modification) was the surgical procedure used. A classic Hartmann resection was performed in 63 of 78 patients, i.e., following removal of the distal segment, the rectal stump was closed. A modified Hartmann resection was performed in 15 patients (19.2 per cent), where a distal mucous fistula was created to facilitate subsequent colostomy closure. Hemorrhage was a common problem during the procedure (37.2 per cent) and other organ injury was uncommon. The wound infection rate was 24.4 per cent. Nine per cent of patients required a second operation for treating postoperative complications. Two of the patients died; the mortality was 2.6 per cent. Recommendations include the creation of a distal mucous fistula when possible. Minimal resection of the distal segment may often permit this and will allow easier closure of the colostomy.