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Utility of appropriate peritonitis grading in the surgical management of perforated sigmoid diverticulitis
Author(s) -
Thaler K.,
Neumann F.,
Gerö A.,
Kreuzer W.
Publication year - 2000
Publication title -
colorectal disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.029
H-Index - 89
eISSN - 1463-1318
pISSN - 1462-8910
DOI - 10.1046/j.1463-1318.2000.00191.x
Subject(s) - medicine , peritonitis , diverticulitis , perforation , surgery , anastomosis , diverticulosis , diverticular disease , general surgery , materials science , punching , metallurgy
Objective We evaluated the prognostic validity of preoperative risk scores in the surgical management of patients with diverticular perforation and diffuse peritonitis. Patients and methods From 1988 to 1998, 82 patients, mean age 72 ± 15 years, underwent urgent surgery for perforated diverticulitis with generalized peritonitis. They were operated either with the Hartmann technique or with resection and primary anastomosis. ASA Classification and Mannheimer Peritonitis Index (MPI) were documented as risk scores at time of surgery and used as guidelines to decide for one of both procedures. Results A Hartmann resection (HA) was performed in 62 patients (76%) and resection with primary anastomosis (PA) in 20 (24%). Seventy‐one percent of patients in the HA group corresponded to ASA IV/V, compared with 35% in the group with primary anastomosis ( P < 0.001). Patients with Hartmann resection had also a higher MPI (23 ± 8) vs those with primary anastomosis (18 ± 7; P < 0.004). However, differences between the HA group and the PA group due to post‐operative morbidity (21% vs 35%) and mortality (35% vs 20%) did not reach statistical significance. Nevertheless, multivariate analysis of the whole series revealed a significant relationship between MPI and mortality ( P < 0.0043), independent of ASA class, age and operative procedure. Conclusion Patients assigned to Hartmann procedure had more co‐morbidities and more advanced peritonitis as assessed by increased ASA and higher MPI. The Mannheimer Peritonitis Index proved to be an independent prognostic index in estimating mortality with respect to peritonitis extension and septic status of the patient.