Emergent ileocecectomy for infection and inflammation.

The role of right colectomy in controlling inflammatory conditions and intra-abdominal sepsis remains controversial. The objective of this study was to define the outcome following emergency ileocecal resection for infectious and inflammatory causes. Retrospective analysis of 83 consecutive patients who underwent such treatment in a university-affiliated public hospital over a 7-year period was performed. Preoperative diagnosis was correct in 54 per cent of patients; CT scan (29 patients) did not improve this rate (59%). Free perforation was noted in 16 per cent of patients, and a defined abscess was found in 39 per cent. Common pathologic diagnoses included appendicitis (39%), diverticulitis (23%), cancer (14%), and Crohn's disease (8%). Primary ileocolic anastomosis was performed in 74 patients (89%); 9 patients (11%) required an ileostomy. Mean postoperative stay was 10 days, and there was no mortality. Complications occurred in 15 patients (18%), and 2 required reoperation (2%). Preoperative presence of an abscess was not associated with an increased complication rate (16%), but free perforation was associated with a 31 per cent complication rate. Definitive emergency treatment of infectious and inflammatory disease of the ileocecum can be safely accomplished by resection with primary anastomosis in the majority of patients, obviating the need for ileostomy and a second operation.