DIVERTICULAR DISEASE IN AUCKLAND

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Abstract
A retrospective study is presented of 200 cases of diverticular disease admitted to Auckland Hospital over the 6-year period 1979-84. The epidemiology of the total group, the mode or type of presentation, pathology and investigative practice have been examined. Seventy-six patients required surgical intervention either electively or as an emergency and these cases have been considered in detail. The surgical group included 44 men and 32 women; 21 patients presented for elective resection, and 55 patients underwent surgery during their emergency admission. In the emergency group, 20 laparotomies were performed for pericolic/pelvic abscesses, five for small/large bowel obstruction, 30 for peritonitis and only one laparotomy was performed for haemorrhage. The mortality for the entire group was 4% with all deaths occurring in the acute diverticulitis group. Three deaths followed emergency surgery and a further five patients died without coming to surgery, the diagnosis of acute diverticulitis being made only at post-mortem. Overall, 44% of cases of acute diverticulitis underwent emergency surgery and a further 6% required surgery over the next 1-5 years. Resectional surgery was practised widely in the emergency group (the most common being Hartmann''s operation). Less radical surgery is also preferred for localized sepsis in selected cases. The mortality was confined to patients who did not undergo resection of the septic focus. The elective group (24 patients) usually presented as a result of stricture, or chronic symptoms, and these patients generally did well with elective resection. The group of patients presenting with colonic bleeding behaved in a very benign manner. There was no mortality and only one patient required emergency surgery for bleeding.