Abstract
Introduction:
Acute diverticulitis presents in 10%–25% of patients with diverticulosis 1 with urgent operations required in up to 20% of these patients. 2 The role of laparoscopic peritoneal lavage for the management of acute perforated diverticulitis with peritonitis is to provide a minimally invasive approach with the avoidance of the high morbidity and mortality associated with an emergent open surgical resection.
Materials and Methods:
Laparoscopic peritoneal lavage may be indicated in perforated diverticulitis when a percutaneous approach is not feasible or warranted. 3 Key features of the technique include identification of the perforation and copious lavage in all abdominal quadrants and pelvis until all purulent fluid has been aspirated. Placement of drains around the perforation site and the most dependent portions of the fluid collections is warranted. The perforation can be managed with suture repair or an omental or epiploica patch. In cases in which fecal peritonitis is identified, conversion to an open procedure is mandatory. 4,5
Results and Discussion:
We report a case of a 53-year-old male who was presented with generalized peritonitis and computed tomography imagining consistent with perforated diverticulitis. We performed a laparoscopic colonic lavage, primary suture repair of a sigmoid colon perforation with overlay of epiploic appendage and dependent drainage. The goal of laparoscopic lavage is to manage an emergent situation with a minimally invasive approach to obviate the need for an emergent open colon resection. 6 Multiple reports have confirmed this to be a safe alternative with significantly diminished morbidity and mortality. Future considerations for this approach may include the development of a uniformed set of inclusion criteria, the identification of predictors of failure, and the evaluation of the feasibility of laparoscopic lavage serving as definitive treatment without the requirement for future resection.
Runtime of video: 4 mins 17 secs
Video Presentation at the Meeting of the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES), San Diego, CA, March 7 to 10, 2012.
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