Management of acute perforated diverticulitis with generalized peritonitis: is this the end of the Hartmann’s era?

Surgery for diverticular peritonitis

Some patients with acute diverticulitis will present with colonic perforation and peritonitis. This paper is a review of the surgical management of diverticular peritonitis Hinchey III and Hinchey IV. The significance of prompt management of sepsis is discussed. The surgical options for Hinchey III and Hinchey IV peritonitis are discussed with presentation of the supporting literature. In Hinchey III peritonitis Laparoscopic Peritoneal Lavage has emerged as an alternative to laparotomy-colectomy. The classic Hartmann's operation has no advantage of survival and results frequently in permanent stoma. Recent published evidence supports on table colonic lavage and the performance of primary anastomosis unless the patient is critically ill.

[Actual issues of diagnosis and treatment of diverticulitis]

The authors reviewed the main researches devoted to pathophysiological mechanisms and international classification of diverticulitis, analyzed multiple-center retrospective and randomized prospective studies. Modern diagnostic and therapeutic approaches, certain unsolved problems in indications for surgeries and their technique, as well as the role of surgical interventions in prevention of recurrences and severe complications of diverticulitis are demonstrated.