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SURGERY IN COMPLICATED SIGMOID DIVERTICULITIS: RETROSPECTIVE ANALYSIS
Pankaj N. Desai, Dhaval Mangukiya^*, Keyur Bhatt
Surat Institute Of Digestive Diseases, Surat, India

Globally diverticulosis is considered as a western world or developed country disease with prevalance from 5% to 45%. Anatomically 90% diverticulosis involves distal or left sided colon and only 1.5% involves solely right colon. Although its uncommon in asian and african race, incidence increasing due to westerniztion in diet habit i.e. less vegetables or fibre rich food. In Asian scenario prevalance of right colon diverticulosis edges over left colon (1,2). Incidence increases with age perticularly in sigmoid diverticulosis i.e. 60% after age of 80 (3). In India with prevalance of 9% according to south Indian cohort(4) where as 3% as North Indian cohort(5). 46% from total had left colon disease, 40% with right colon and 13% detected with pancolic diverticulosis(4). Various complications can occur with this benign and silent disease namely Bleeding Perforation, Abscess, Fistula, Stricture, Obstruction, Ureteral Obstruction, Phlegmon (Inflammatory mass),Saint’s Triad (Diverticulosis, cholelithiasis and hiatal hernia). Comlications occur in 10 - 25% of cases. It can also creates dilemma for differential diagnosis of malignancy hence requires vigilant attention. CECT abdomen gets grade A recommendation to clinch the diagnosis and guide the management while colonoscopy is detecting many incidental diverticulosis without much role in acute presentations. Paradigm of treatment is shifting more towards conservative approach avoiding emergency exploration and morbid multistage interventions like hartmann's procedure. Laparoscopy is preferable choice in elective procedure. A multicenter randomized of primary anastomosis or Hartmann's Procedure for perforated left colonic diverticulitis with purulent or fecal peritonitis showed favorble results for primary anastomosis(6).
We represent retrospective analysis and outcome in last 18 months of tertiary centre of South Gujarat where in 2445 colonoscopy we detected 198 diverticulosis (8%). Pancolic diverticuli were most common i.e. 44% (89/198) followed by left side (31%) and right side (23%). Total 21 patients admitted for symptomatic diverticular disease in which 18 admissions were for sigmoid diverticulitis with average age of 61 years. Most common presenting symptom was bleeding per rectum in our study. Emergency surgery was required in 16 patients, from which primary anastomosis with diverting stoma was done in 14 patients where as hartmann's procedure done in 2 patients. Two patients underwent elective surgery, one after putting pigtail and second for stricture. Mortality in one patient, who had second stage surgery for hartmann's reversal. To conclude, incidence of complicated sigmoid divertilculitis is more requiring intervention as compare to other parts of bowel. Primary anastomosis should be choice of surgery with or without diversion which depends on intra operative findings.

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