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Laparoscopic Peritoneal Lavage for Complicated Sigmoid Diverticulitis

John C Friel, John J Kelly, Richard Perugini, Craig Paterson, Timothy Counihan
UMass Medical School, Worcester, MA

Objective(s):
Traditional therapy for diffuse peritonitis secondary to perforated sigmoid diverticulitis is emergency colectomy with colostomy. We have evaluated laparoscopic exploration with peritoneal lavage as an alternative to traditional operative strategies in patients who require emergency surgery for diverticulitis.
Design:
Case report.
Setting:
University medical center.
Patients:
Seven patients with a mean age of 49.2 years, with generalized peritonitis secondary to sigmoid diverticulitis were included in this study. Six patients presented with diffuse peritonitis, one with a failure to improve after percutaneous abscess drainage.
Interventions:
All patients were explored laparoscopically and the peritoneal cavity was lavaged with saline. Broad spectrum antibiotics were administered to all patients.
Main Outcome Measure(s):
Clinical outcome, length of stay, complications.
Results:
In six patients, peritonitis resolved and patients were discharged from the hospital. One patient did not respond to laparosopic lavage and required open exploration and abscess drainage. One patient had a recurrent abscess requiring percutaneous drainage. This patient went on to have a second bout of diverticulitis requiring emergency colectomy. Four patients had elective laparoscopic sigmoid resections, one had an open resection, and one is planned for the future. No patients had fecal peritonitis. One patient developed Clostridium difficile colitis. There was no mortality. Mean length of stay was 7.7 days.
Conclusions:
Laparoscopic exploration and peritoneal lavage can be performed safely in patients with diffuse purulent peritonitis. Using this aproach, most patients (6/7 or 86%) with purulent peritonitis can avoid emergent resectional surgery and colostomy formation.

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