The outcome of staged management of complicated diverticular disease of the sigmoid colon.

In a retrospective study, 83 consecutive patients with indication for a staged treatment of complicated diverticular disease were reviewed. There was a considerable overall morbidity rate following construction of the colostomy, colonic resection, and colostomy closure. However, only 58% underwent a resection of the diseased segment, and even fewer (46%) obtained an eventual restoration of the colon continuity. This was primarily due to an unacceptable high mortality rate when patients with general peritonitis were managed by a proximal colostomy and drainage only. Subsequently, advanced age and associated major illness in patients with a planned three-stage management were the most important factors, determining the deficient completion of the staged treatment. Due to the permanence of many transverse colostomies but also to the fact that serious anastomotic complications, including fatal consequences, occurred despite a defunctioning colostomy, one should re-evaluate the need for a proximal colostomy in patients at high risk, considering resection and an end sigmoid colostomy which is the superior permanent stoma if reconstruction fails to come.