Diverticulitis with perforation into the peritoneal cavity.

Sigmoid diverticulitis with free perforation or perforation through the mesentery results in generalized peritonitis. Emergency surgical treatment is mandatory, but the most efficacious procedure has not been clearly established. Ten consecutive patients were treated by removal of the perforated sigmoid colon, temporary end colostomy and peritoneal toilet. All but one patient survived the initial procedure, and there were only four minor complications. The preoperative diagnosis was correct in 8 of the 10 patients. Analysis of the preoperative clinical findings revealed that a decision in favor of immediate operation was not difficult. The predominant clinical manifestations were severe abdominal pain and tenderness, fever, and elevation of the white blood cell count. The most reliable diagnostic finding was localization of the area of maximum tenderness to the left lower quadrant and suprapubic areas. While it is not applicable for all the pathologic manifestations of diverticulitis, sigmoid colectomy, temporary end colostomy and peritoneal toilet is efficacious therapy in perforative diverticulitis with free communication between the colonic lumen and the peritoneal cavity.