Acute perforated diverticulitis of the colon as a rare cause for development of abdominal compartment syndrome

Abstract

Aim: The aim of the present retrospective study was to assess the surgical approaches to acute perforated diverticulitis of the colon causing peritonitis and in some cases complicated with abdominal compartment syndrome (ACS).

Patients and methods: A total of eight patients (6 males and 2 females) have been operated on for 5 years for perforated diverticulum of the colon. The males had a mean age of 72 +/- 2.6 years and the females--69 +/- 3.1 years. Case history records of the patients were studied retrospectively to evaluate the effectiveness of different surgical approaches used in patients with such disorders. The females had perforation of cecal diverticulum, five of the males had perforated diverticulum of the sigmoid colon and one had perforation of diverticulum of the descending colon. The diagnosis in all patients was made intraoperatively and only in two cases was it assumed prior to operation. In the female patient with cecal pathology right-sided hemicolectomy with primary anastomosis was performed. In the other six patients Hartmann's procedure was applied with a subsequent second-stage intervention to restore the intestinal continuity.

Results: Total feculent peritonitis was found in four of the patients with perforated diverticulum of the sigmoid colon, with signs of multiorgan failure, intra-abdominal hypertension (IAH >25 cm H2O level) and developed ACS. Despite the severity of the condition there was no lethal outcome. Two patients developed incisional hernia on the anterior abdominal wall.

Conclusion: Based on the retrospective clinical analysis the authors conclude that primary hemicolectomy with one-stage anastomosis is the best procedure in patients in good condition and early stage on Hinchey classification. Total feculent peritonitis, associated with stage IV on Hinchey classification and signs of ACS requires Hartmann's procedure, following the principles of damage control surgery with obligatory use of temporary abdominal closure technique to control the syndrome and prevent a secondary one in the postoperative period. The indirect intravesical method of verification of IAH and ACS (the golden standard) is sufficiently precise for the clinical practice.