Management of Perforative Sigmoid Diverticulitis With Diffusing Peritonitis

Abstract

PERFORATION with diffusing peritonitis is an infrequent but often fatal complication of colonic diverticulitis. It occurs almost always as the result of sigmoid diverticulitis, frequently is unheralded, and always produces signs of acute peritonitis. The frequency of this complication varies depending upon the series examined. All cases of diverticulitis are included in some reports, thus lowering the incidence of acute perforative diverticulitis considerably; in other series this complication is reported relative only to patients with diverticulitis who were operated on. The proportion of acute cases will also depend to some extent on the type of institution reporting. Thus, the published incidence of free perforation with diffuse peritonitis varies from less than 1% to as high as 17%.^1-4 Various means of managing this complication have been advocated. The most generally accepted treatment is proximal colostomy, usually in the transverse colon, and local drainage of the site of perforation. Others prefer