[Prospective national study of complicated diverticulitis in Great Britain].
Three hundred cases of complicated diverticular disease were entered into a national audit organised by the Surgical Research Society from 30 hospitals between 1985 and 1988. Admission complications included acute phlegmon (n = 104), pericolic abscess (n = 34), purulent peritonitis (n = 40), large bowel obstruction (n = 31), faecal peritonitis (n = 23), pericolic abscess complicated by fistula (n = 28) and lower GI bleeding (n = 40). The overall mortality was only 11% (4% acute phlegmon, 27% purulent peritonitis, 12% pericolic abscess, 48% faecal peritonitis, 6% large bowel obstruction, 2.5% bleeding, 3.5% fistula). Acute phlegmon was managed non-operatively in 75% and by resection in 23%. Purulent peritonitis was generally managed by Hartmann resection (62%) or by resection and primary anastomosis (15%). Similarly pericolic abscess was usually managed by Hartmann resection (38%) or resection and primary anastomosis (35%). The principal operation for faecal peritonitis was Hartmann resection (83%). Large bowel obstruction was either managed conservatively (13%), by Hartmann resection (29%) or by resection and primary anastomosis with and without a proximal stoma (42%). Most fistulas associated with an abscess were managed by resection and primary anastomosis (82%) and acute GI bleeding was usually managed non-operatively (90%).
Morton
D G
DG
University Department of Surgery, Queen Elizabeth Hospital, Birmingham, Grossbritannien.
Keighley
M R
MR
D018784:Abdominal Abscess / Q000209:etiology / Q000401:mortality / Q000601:surgery; D000714:Anastomosis, Surgical; D002423:Cause of Death; D003108:Colonic Diseases / Q000209:etiology / Q000401:mortality / Q000601:surgery; D003125:Colostomy; D003430:Cross-Sectional Studies; D004239:Diverticulitis, Colonic / Q000150:complications / Q000401:mortality / Q000601:surgery*; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000401:mortality / Q000601:surgery; D006801:Humans; D015994:Incidence; D007412:Intestinal Fistula / Q000209:etiology / Q000401:mortality / Q000601:surgery; D007416:Intestinal Perforation / Q000209:etiology / Q000401:mortality / Q000601:surgery; D008485:Medical Audit; D010538:Peritonitis / Q000209:etiology / Q000401:mortality / Q000601:surgery; D011183:Postoperative Complications / Q000401:mortality; D011446:Prospective Studies; D015996:Survival Rate; D016896:Treatment Outcome; D006113:United Kingdom / Q000453:epidemiology