title: Same admission colon resection with primary anastomosis for acute diverticulitis.
abstract: Current standard of care for complicated diverticulitis includes urgent resection with colostomy versus antibiotic treatment, followed by delayed resection with primary anastomosis at a second admission. In certain circumstances, it is possible to perform resection and anastomosis on the same admission for acute diverticulitis. A retrospective review was completed for patients undergoing surgery for diverticulitis from 1991 to 1998. Groups included: 1) sigmoid resection with primary anastomosis on same admission (n = 18); 2) resection with protective end colostomy (n = 16); and 3) in-patient antibiotic treatment alone, followed by a second admission for resection with primary anastomosis (n = 5). Four patients initially treated with antibiotics worsened symptomatically or developed radiographic evidence of perforation and required resection with colostomy. Five patients in Group 1 had abscesses or contained perforations based on radiographic studies. Findings on CT scans did not predict treatment. Group 1 patients had uneventful recoveries and few minor complications (wound infections and an incisional hernia). One anastomotic leak occurred in Group 2 after colostomy closure. Although there will continue to be a role for emergent operation for diverticulitis, same admission sigmoid resection with primary anastomosis after antibiotic treatment is safe, uses a shorter course of antibiotics, and has a low complication rate.
authors.affiliation: Department of Surgery, Olive View-University of California at Los Angeles Medical Center, Sylmar, USA.
authors.forename: M A
authors.initials: MA
authors.lastname: Maggard
authors.forename: J E
authors.initials: JE
authors.lastname: Thompson
authors.forename: P J
authors.initials: PJ
authors.lastname: Schmit
authors.forename: C F
authors.initials: CF
authors.lastname: Chandler
authors.forename: R S
authors.initials: RS
authors.lastname: Bennion
authors.forename: A
authors.initials: A
authors.lastname: Au
authors.forename: O J
authors.initials: OJ
authors.lastname: Hines
mesh_terms: D000208:Acute Disease; D000328:Adult; D000714:Anastomosis, Surgical; D012809:Colon, Sigmoid / Q000601:surgery*; D013505:Digestive System Surgical Procedures / Q000379:methods; D004239:Diverticulitis, Colonic / Q000601:surgery*; D006760:Hospitalization; D006801:Humans; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies