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. 1984 Oct;200(4):466–478. doi: 10.1097/00000658-198410000-00008

Changing patterns in the surgical treatment of diverticular disease.

G V Rodkey, C E Welch
PMCID: PMC1250513  PMID: 6333217

Abstract

This paper includes a brief historic summary of the surgical aspects of diverticular disease and of corresponding developments in the Massachusetts General Hospital from 1911 to the present. The 350 cases observed in 1974-1983 are compared with 338 seen in the previous decade. Major trends include a decrease in hospital admissions for diverticular disease but a sustained number of operations; increased severity of the disease in hospitalized patients manifested by an increased percentage of patients with immunosuppression or serious other diseases (p less than 0.001), an increased number with sepsis and general peritonitis (p less than 0.001); an increased percentage of cases with one-stage resection and anastomosis (p less than 0.02); in patients with general peritonitis, resection of the perforated segment at the time of the original operation was accompanied by the lowest mortality (p less than 0.02); incidental splenectomy appears to be dangerous, with three deaths in eight cases; and overall mortality in the last decade is 6.4%; for emergency cases 10.2%, for urgent 9.7%, and for elective cases 2.4%.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Alexander J., Karl R. C., Skinner D. B. Results of changing trends in the surgical management of complications of diverticular disease. Surgery. 1983 Oct;94(4):683–690. [PubMed] [Google Scholar]
  2. BOLES R. S., Jr, JORDAN S. M. The clinical significance of diverticulosis. Gastroenterology. 1958 Dec;35(6):579–582. [PubMed] [Google Scholar]
  3. Charnock F. M., Rennie J. R., Wellwood J. M., Todd I. P. Results of colectomy for diverticular disease of the colon. Br J Surg. 1977 Jun;64(6):417–419. doi: 10.1002/bjs.1800640612. [DOI] [PubMed] [Google Scholar]
  4. Drapanas T., Pennington D. G., Kappelman M., Lindsey E. S. Emergency subtotal colectomy: preferred approach to management of massively bleeding diverticular disease. Ann Surg. 1973 May;177(5):519–526. doi: 10.1097/00000658-197305000-00003. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. EDWARDS H. C. Intestinal diverticulosis and diverticulitis. Ann R Coll Surg Engl. 1954 Jun;14(6):371–388. [PMC free article] [PubMed] [Google Scholar]
  6. Eng K., Ranson J. H., Localio S. A. Resection of the perforated segment. A significant advance in treatment of diverticulitis with free perforation or abscess. Am J Surg. 1977 Jan;133(1):67–72. doi: 10.1016/0002-9610(77)90195-7. [DOI] [PubMed] [Google Scholar]
  7. FLEISCHNER F. G., HENKEN E. M., MING S. C. REVISED CONCEPTS ON DIVERTICULAR DISEASE OF THE COLON. I. DIVERTICULOSIS: EMPHASIS ON TISSUE DERANGEMENT AND ITS RELATION TO THE IRRITABLE COLON SYNDROME. Radiology. 1964 Nov;83:859–872. doi: 10.1148/83.5.859. [DOI] [PubMed] [Google Scholar]
  8. Gallagher J. J., Welch J. P. Giant diverticular of the sigmoid colon: a review of differential diagnosis and operative management. Arch Surg. 1979 Sep;114(9):1079–1083. doi: 10.1001/archsurg.1979.01370330101020. [DOI] [PubMed] [Google Scholar]
  9. Gouge T. H., Coppa G. F., Eng K., Ranson J. H., Localio S. A. Management of diverticulitis of the ascending colon. 10 years' experience. Am J Surg. 1983 Mar;145(3):387–391. doi: 10.1016/0002-9610(83)90208-8. [DOI] [PubMed] [Google Scholar]
  10. HARTLEY R. C. DANGERS OF DIVERTICULITIS COLI. AN ESTIMATION OF THE PLACE OF RESECTION IN AVOIDANCE OF COMPLICATIONS. Br J Surg. 1964 Jan;51:45–49. doi: 10.1002/bjs.1800510109. [DOI] [PubMed] [Google Scholar]
  11. HORNER J. L. Natural history of diverticulosis of the colon. Am J Dig Dis. 1958 May;3(5):343–350. doi: 10.1007/BF02232401. [DOI] [PubMed] [Google Scholar]
  12. HUGHES E. S., CUTHBERTSON A. M., CARDEN A. B. The surgical management of acute diverticulitis. Med J Aust. 1963 May 25;50(1):780–782. [PubMed] [Google Scholar]
  13. Havia T., Manner R. The irritable colon syndrome. A follow-up study with special reference to the development of diverticula. Acta Chir Scand. 1971;137(6):569–572. [PubMed] [Google Scholar]
  14. Judd E. S., Pollock L. W. DIVERTICULITIS OF THE COLON. Ann Surg. 1924 Sep;80(3):425–438. doi: 10.1097/00000658-192409000-00014. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. LARGE J. M. TREATMENT OF PERFORATED DIVERTICULITIS. Lancet. 1964 Feb 22;1(7330):413–414. doi: 10.1016/s0140-6736(64)92790-4. [DOI] [PubMed] [Google Scholar]
  16. LAURIDSEN J., ROSS F. P. Acute diverticulitis of the cecum; a report of four cases and review of one hundred fifty-three surgical cases. AMA Arch Surg. 1952 Mar;64(3):320–330. [PubMed] [Google Scholar]
  17. MACLAREN I. F. Perforated diverticulitis: a survey of 75 cases. J R Coll Surg Edinb. 1957 Dec;3(2):129–144. [PubMed] [Google Scholar]
  18. MADDEN J. L., TAN P. Y. Primary resection and anastomosis in the treatment of perforated lesions of the colon, with abscess or diffusing peritonitis. Surg Gynecol Obstet. 1961 Nov;113:646–650. [PubMed] [Google Scholar]
  19. Morgenstern L., Weiner R., Michel S. L. 'Malignant' diverticulitis: a clinical entity. Arch Surg. 1979 Oct;114(10):1112–1116. doi: 10.1001/archsurg.1979.01370340018002. [DOI] [PubMed] [Google Scholar]
  20. Ouriel K., Schwartz S. I. Diverticular disease in the young patient. Surg Gynecol Obstet. 1983 Jan;156(1):1–5. [PubMed] [Google Scholar]
  21. PAINTER N. S., TRUELOVE S. C. Potential dangers of morphine in acute diverticulitis of the colon. Br Med J. 1963 Jul 6;2(5348):33–34. doi: 10.1136/bmj.2.5348.33. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Parks T. G., Connell A. M. The outcome in 455 patients admitted for treatment of diverticular disease of the colon. Br J Surg. 1970 Oct;57(10):775–778. doi: 10.1002/bjs.1800571021. [DOI] [PubMed] [Google Scholar]
  23. Peck D. A., Labat R., Waite V. C. Diverticular disease of the right colon. Dis Colon Rectum. 1968 Jan-Feb;11(1):49–54. doi: 10.1007/BF02616745. [DOI] [PubMed] [Google Scholar]
  24. Penfold J. C. Management of uncomplicated diverticular disease by colonic resection in patients at St. Mark's Hospital, 1964-9. Br J Surg. 1973 Sep;60(9):695–698. doi: 10.1002/bjs.1800600909. [DOI] [PubMed] [Google Scholar]
  25. RYAN P. Emergency resection and anastomosis for perforated sigmoid diverticulitis. Br J Surg. 1958 May;45(194):611–616. doi: 10.1002/bjs.18004519409. [DOI] [PubMed] [Google Scholar]
  26. Reilly M. C. Colonic diverticula. Surgical management. Br Med J. 1970 Sep 5;3(5722):570–573. doi: 10.1136/bmj.3.5722.570. [DOI] [PMC free article] [PubMed] [Google Scholar]
  27. Rodkey G. V., Welch C. E. Colonic diverticular disease with surgical treatment. A study of 338 cases. Surg Clin North Am. 1974 Jun;54(3):655–674. doi: 10.1016/s0039-6109(16)40340-3. [DOI] [PubMed] [Google Scholar]
  28. Rodkey G. V., Welch C. E. Diverticulitis of the colon: evolution in concept and therapy. Surg Clin North Am. 1965 Oct;45(5):1231–1243. doi: 10.1016/s0039-6109(16)37690-3. [DOI] [PubMed] [Google Scholar]
  29. SMITHWICK R. H. Surgical treatment of diverticulitis of the sigmoid. Am J Surg. 1960 Feb;99:192–205. doi: 10.1016/0002-9610(60)90114-8. [DOI] [PubMed] [Google Scholar]
  30. Smithwick R. H. EXPERIENCES WITH THE SURGICAL MANAGEMENT OF DIVERTICULITIS OF THE SIGMOID. Ann Surg. 1942 Jun;115(6):969–985. doi: 10.1097/00000658-194206000-00010. [DOI] [PMC free article] [PubMed] [Google Scholar]
  31. Torsoli A., Ramorino M. L., Crucioli V. The relationships between anatomy and motor activity of the colon. Am J Dig Dis. 1968 May;13(5):462–467. doi: 10.1007/BF02233670. [DOI] [PubMed] [Google Scholar]
  32. WELCH C. E., ALLEN A. W., DONALDSON G. A. An appraisal of resection of the colon for diverticulitis of the sigmoid. Ann Surg. 1953 Sep;138(3):332–343. doi: 10.1097/00000658-195313830-00005. [DOI] [PMC free article] [PubMed] [Google Scholar]
  33. Watkins G. L., Oliver G. A. Management of perforative sigmoid diverticulitis with diffusing peritonitis. Arch Surg. 1966 Jun;92(6):928–933. doi: 10.1001/archsurg.1966.01320240116024. [DOI] [PubMed] [Google Scholar]
  34. Welch C. E., Athanasoulis C. A., Galdabini J. J. Hemorrhage from the large bowel with special reference to angiodysplasia and diverticular disease. World J Surg. 1978 Jan;2(1):73–83. doi: 10.1007/BF01574466. [DOI] [PubMed] [Google Scholar]

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