Email this article Strategy of stage treatment for patients with perforated diverticulitis: first experience
- Authors: Bezmozgin B.G.1, Poryvaeva E.V.2, Pirozhkova E.A.1, Babkov O.V.1, Yastrebov I.P.1, Batyrshin I.M.1, Surov D.A.1,3, Demko A.E.1,3
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Affiliations:
- Saint Petersburg Research Institute of Emergency Medicine named after I.I. Dzhanelidze
- North-Western State Medical University named after I.I. Mechnikov
- Kirov Military Medical Academy
- Issue: Vol 15, No 4 (2023)
- Pages: 31-40
- Section: Original research
- URL: https://journals.eco-vector.com/vszgmu/article/view/601813
- DOI: https://doi.org/10.17816/mechnikov601813
- ID: 601813
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Abstract
BACKGROUND: The results of surgical treatment of patients with perforative diverticulitis of the colon are still unsatisfactory today. Since the majority of patients undergo Hartmann surgery, the main problem is a large number of stoma patients. Three quarters of them live with a stoma for a long time, which negatively affects their quality of life and increases the cost of treatment.
AIM: The purpose of this research work is to improve the immediate results of treating patients with perforative diverticulitis and peritonitis by using staged surgical tactics.
MATERIALS AND METHODS: The reaserach included 14 patients with perforative diverticulitis Hinchey grade II-III. The average value of the Mannheim peritoneal index is 18.9 ± 6.3 points. At the first stage of surgical treatment, all the patients underwent colon resection with a zone of perforation of the diverticulum and leaving its muffled ends in the abdominal cavity. After lavage and drainage, temporary closure of the anterior abdominal wall was performed. After 24–48 hours, all the patients underwent colon reconstraction.
RESULTS: The average age of the patients was 52.3 ± 12.4 years with 4 women (28.6%) and 10 men (71.4%). The average duration of the first stage was 105.7 ± 27.2 minutes, the second one — 113.2 ± 40.5 minutes. The average hospital-stays were 16.4 ± 7.2 days. There were no anastomosis failures and no lethal outcomes. Complications were noted in 9 patients (64.3%), grade I according to Clavien – Dindo — 83.4%.
CONCLUSIONS: The tactics of early surgical treatment is a promising concept for patients with perforative diverticulitis. It provides rapid elimination of the septic focus during the first surgical operation, assumes early reconstruction of the intestine without increasing the number of complications and mortality, and can be used in patients with peritonitis.
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About the authors
Boris G. Bezmozgin
Saint Petersburg Research Institute of Emergency Medicine named after I.I. Dzhanelidze
Author for correspondence.
Email: bezkard@mail.ru
MD
Russian Federation, 3A Budapeshtskaya St., Saint Petersburg, 192242Evita V. Poryvaeva
North-Western State Medical University named after I.I. Mechnikov
Email: eeporyvaeva@gmail.com
MD
Russian Federation, Saint PetersburgEkaterina A. Pirozhkova
Saint Petersburg Research Institute of Emergency Medicine named after I.I. Dzhanelidze
Email: ekaterina.pirozhkova93@mail.ru
MD
Russian Federation, 3A Budapeshtskaya St., Saint Petersburg, 192242Oleg V. Babkov
Saint Petersburg Research Institute of Emergency Medicine named after I.I. Dzhanelidze
Email: oleg.babckov@yandex.ru
SPIN-code: 3214-7704
MD, Cand. Sci. (Med.)
Russian Federation, 3A Budapeshtskaya St., Saint Petersburg, 192242Ivan P. Yastrebov
Saint Petersburg Research Institute of Emergency Medicine named after I.I. Dzhanelidze
Email: ipyastreb@gmail.com
MD
Russian Federation, 3A Budapeshtskaya St., Saint Petersburg, 192242Ildar M. Batyrshin
Saint Petersburg Research Institute of Emergency Medicine named after I.I. Dzhanelidze
Email: onrush@mail.ru
ORCID iD: 0000-0003-0241-7902
SPIN-code: 5287-7599
MD, Dr. Sci. (Med.)
Russian Federation, 3A Budapeshtskaya St., Saint Petersburg, 192242Dmitry A. Surov
Saint Petersburg Research Institute of Emergency Medicine named after I.I. Dzhanelidze; Kirov Military Medical Academy
Email: sda120675@mail.ru
SPIN-code: 5346-1613
Scopus Author ID: 445844
MD, Dr. Sci. (Med.), Assistant Professor
Russian Federation, 3A Budapeshtskaya St., Saint Petersburg, 192242; Saint PetersburgAndrey E. Demko
Saint Petersburg Research Institute of Emergency Medicine named after I.I. Dzhanelidze; Kirov Military Medical Academy
Email: demko@emergency.spb.ru
ORCID iD: 0000-0002-5606-288X
SPIN-code: 3399-8762
MD, Dr. Sci. (Med.), Professor, Honored Doctor of the Russian Federation
Russian Federation, 3A Budapeshtskaya St., Saint Petersburg, 192242; Saint PetersburgReferences
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СМИ зарегистрировано Федеральной службой по надзору в сфере связи, информационных технологий и массовых коммуникаций (Роскомнадзор).