Complicated colonic diverticulosis: surgical perspective from an Indian Centre.
BACKGROUND
Colonic diverticulosis was previously uncommon in India but its incidence seems to have increased recently. Patients with the disease in developing countries are also underdiagnosed and are therefore more likely to present with complications needing operation. However there is a paucity of surgical data on the condition.


METHODS
Between August 1996 and February 2005 we operated on 32 patients (28 males, 4 females mean age 60 years) with colonic diverticulosis and analysed their characteristics from a prospective database. We here with describe our experience.


RESULTS
Operations for diverticular disease constituted 3% of all the colorectal operations we performed. The diverticula were in the sigmoid colon in 28 (88%) and also in the descending colon in 4 (12%). Twenty-four patients were symptomatic. Twenty-two patients were diagnosed before surgery, 8 at operation and the rest from resected specimens. Emergency operations were performed in 23 and elective procedures in 9 patients. Ten patients were operated on for perforation and abscess, 8 for obstruction, 8 for colovesical fistula, 3 for peritonitis and 3 for haemorrhage. Emergency procedures were performed in 2 stages (resection plus a proximal diversion) in 20; unless done for bleeding in a stable patient where a primary anastomosis was done. One patient who had had an emergency procedure died of sepsis and ketoacidosis in the post-operative period. The 8 patients with colovesical fistulae were all males, had only sigmoid involvement and had had symptoms for a longer duration than the 24 without fistulae.


CONCLUSIONS
Although operations for colonic diverticulosis still form a small proportion of the total number of colorectal operations, the diagnosis is often delayed till complications ensue and thus patients usually require emergency procedures. Males with long standing symptoms and sigmoid diverticula may develop colovesical fistulae.
Kakodkar
Rahul
R
Department of Surgical Gastroenterology, Sir Ganga Ram Hospital, New Delhi 110060, India.
Gupta
Subash
S
Nundy
S
S
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D043963:Diverticulosis, Colonic / Q000150:complications* / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D006801:Humans; D007194:India; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index