Treatment of diverticulitis of the large intestine and its complications

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Abstract
Summary and Conclusions There is no intra-abdominal surgical condition requiring more judgment concerning the indications for definitive surgery or the management of acute complications than diverticulitis. It is my feeling from observing the service cases in hospitals with which I am associated that more errors are made by doing too much than too little during the surgical procedure. This applies to the acute emergencies and also to the elective operations. Patients with free perforation or abscess formation from acute diverticulitis rarely, if ever, need a proximal colostomy. In the 27 cases in this series, there was a mortality rate of 7.5 per cent after simple closure of the performation and drainage. In patients with fistula formation or complete obstruction, it is essential that a proximal colostomy be performed before definitive surgery. In most patients needing definitive surgery for diverticulitis and in many instances in partial obstruction from acute diverticulitis, a one-stage operation can be performed without a proximal colostomy. Massive hemorrhage was a most unusual complication in this group of patients and presented no surgical problem.

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