Emergency operations for nondiverticular perforation of the left colon.
OBJECTIVE
Although diverticulitis is the most common cause of large bowel perforation, other disease may result in left colonic peritonitis. The aim of this study was to evaluate and compare the incidence, management, and outcome of patients with different causes of nondiverticular left colonic perforations.


METHODS
From January 1992 to September 2000, 212 surgical patients underwent emergency operation for distal colonic peritonitis. Perforations were caused by diverticulitis in 133 patients (63%) and by a nondiverticular process in 79 (37%). Mortality and morbidity in patients with nondiverticular perforation of the distal large bowel its relationship with the general conditions, the grade and the cause of peritonitis were analysed. Four types of surgical procedures were used. Hartmann's procedure was performed in 40 patients (51%); intraoperative colonic lavage, resection, and primary anastomosis (ICL) in 27 patients (34%); colostomy in 7 (9%); and subtotal colectomy in 5 (6%).


RESULTS
Perforated neoplasm, the most common cause of peritonitis, was observed in 30 patients, colonic ischemia in 20, iatrogenia in 13, and other causes in 16 patients. One or more complications were observed in 57 patients (72%); among causes of perforation, colonic ischemia was significantly associated with the longest hospital stay and highest mortality. Eighteen patients (23%) died.


CONCLUSIONS
Left large bowel perforation by nondiverticular disease is associated with high mortality and morbidity. The prognosis of patients is determined by the development of septic shock and colonic ischemia, as underlying disease, may influence patient survival.
Biondo
Sebastiano
S
Department of Surgery, Colorectal Unit, Ciudad Sanitaria y Universitaria de Bellvitge, University of Barcelona, Barcelona, Spain. sbiondo@csub.scs.es
Parés
David
D
Martí Ragué
Juan
J
De Oca
Javier
J
Toral
David
D
Borobia
Francisco G
FG
Jaurrieta
Eduardo
E
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D000714:Anastomosis, Surgical; D016009:Chi-Square Distribution; D003082:Colectomy / Q000379:methods; D003108:Colonic Diseases / Q000150:complications / Q000401:mortality / Q000601:surgery*; D004630:Emergencies; D004638:Emergency Treatment / Q000379:methods; D005260:Female; D006801:Humans; D007416:Intestinal Perforation / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010538:Peritonitis / Q000150:complications / Q000401:mortality / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology; D011336:Probability; D012189:Retrospective Studies; D018570:Risk Assessment; D015996:Survival Rate; D016896:Treatment Outcome