Login to MyKarger

New to MyKarger? Click here to sign up.



Login with Facebook

Forgot your password?

Authors, Editors, Reviewers

For Manuscript Submission, Check or Review Login please go to Submission Websites List.

Submission Websites List

Institutional Login
(Shibboleth or Open Athens)

For the academic login, please select your country in the dropdown list. You will be redirected to verify your credentials.

Original Paper

Prognostic Factors of Perforated Sigmoid Diverticulitis in the Elderly

Mäkelä J.T. · Kiviniemi H. · Laitinen S.

Author affiliations

Department of Surgery, Division of Gastroenterology, Oulu University Hospital, Oulu, Finland

Related Articles for ""

Dig Surg 2005;22:100–106

Do you have an account?

Login Information





Contact Information












By signing up for MyKarger you will automatically participate in our year-End raffle.
If you Then Do Not wish To participate, please uncheck the following box.

Yes, I wish To participate In the year-End raffle And Get the chance To win some Of our most interesting books, And other attractive prizes.


I have read the Karger Terms and Conditions and agree.



Login Information





Contact Information












By signing up for MyKarger you will automatically participate in our year-End raffle.
If you Then Do Not wish To participate, please uncheck the following box.

Yes, I wish To participate In the year-End raffle And Get the chance To win some Of our most interesting books, And other attractive prizes.


I have read the Karger Terms and Conditions and agree.



To view the fulltext, please log in

To view the pdf, please log in

Buy

  • FullText & PDF
  • Unlimited re-access via MyKarger
  • Unrestricted printing, no saving restrictions for personal use
read more

CHF 38.00 *
EUR 35.00 *
USD 39.00 *

Select

KAB

Buy a Karger Article Bundle (KAB) and profit from a discount!

If you would like to redeem your KAB credit, please log in.


Save over 20% compared to the individual article price.
Learn more

Rent/Cloud

  • Rent for 48h to view
  • Buy Cloud Access for unlimited viewing via different devices
  • Synchronizing in the ReadCube Cloud
  • Printing and saving restrictions apply

Rental: USD 8.50
Cloud: USD 20.00


Select

Subscribe

  • Access to all articles of the subscribed year(s) guaranteed for 5 years
  • Unlimited re-access via Subscriber Login or MyKarger
  • Unrestricted printing, no saving restrictions for personal use
read more

Subcription rates


Select

* The final prices may differ from the prices shown due to specifics of VAT rules.

Article / Publication Details

First-Page Preview
Abstract of Original Paper

Published online: May 11, 2005
Issue release date: May 2005

Number of Print Pages: 7
Number of Figures: 0
Number of Tables: 4

ISSN: 0253-4886 (Print)
eISSN: 1421-9883 (Online)

For additional information: https://www.karger.com/DSU

Abstract

Background: The Finnish population is aging fast and the prevalence of perforated sigmoid diverticulitis is simultaneously increasing in northern Finland. The fact that an increasing number of elderly patients, with their age-specific problems, are subjected to emergency surgery for acute diverticulitis underlines the importance of risk stratification.Methods: One hundred and seventy-two patients admitted to Oulu University Hospital because of diverticular perforation from 1983 to 2002 were identified from the computer database. The clinical variables were evaluated as prognostic indicators of postoperative complications, mortality and time of hospitalization. Results: The resection rate was 91%; 64 primary anastomoses, 93 Hartmann’s procedures and two covering colostomies were performed. The overall complication rate was 33%. In patients under 70 years, a stepwise logistic regression analysis showed that the Mannheim Peritonitis Index (MPI) score and American Society of Anesthesiologists (ASA) score were independent prognostic factors. None of factors predicted morbidity in patients over 70 years. Overall mortality rate was 8%, without any significant difference between the procedures. Of the clinical variables, MPI score, ASA score, Hinchey classes and malnutrition correlated with mortality. All patients who died presented with ASA scores of III–IV, and 12 out of 14 patients had an MPI score of II. In a stepwise logistic regression analysis, only the MPI score seemed to be an independent predictor of mortality. Conclusions: Mortality is related to age but age alone is not an independent predictor of mortality. The MPI score is useful in predicting the risk of death in patients with perforated diverticulitis.

© 2005 S. Karger AG, Basel


References

  1. Rothenburger DA, Wiltz O: Surgery for complicated diverticulitis. Surg Clin North Am 1993;73:975–992.
    External Resources
  2. Parks TG: Natural history of diverticular disease of colon: A review of 521 cases. BMJ 1969;4:639–642.
  3. Wolff BG, Devine RM: Surgical management of diverticulitis. Am Surg 2000;66:153–156.
  4. Schoetz DJ Jr: Diverticular disease of the colon. A century-old problem. Dis Colon Rectum 1999;42:703–706.
  5. Schwesinger WH, Page CP, Gaskill HV III, Steward RM, Chopra S, Strodel WE: Sirinek operative management of diverticular emergencies: Strategies and outcomes. Arch Surg 2000;135:558–563.
  6. Mäkelä J, Kiviniemi H, Laitinen S: Prevalence of perforated sigmoid diverticulitis is increasing. Dis Colon Rectum 2002;45:955–961.
  7. Cullen DJ, Apolone G, Greenfield S, Guadagnoli E, Cleary P: ASA physical status and age predict morbidity after three surgical procedures. Ann Surg 1994;220:3–9.
  8. Hinchey EJ, Schaal PG, Richards GK: Treatment of perforated diverticular disease. Adv Surg 1978;12:85–109.
  9. Wacha H, Linder MM, Feldmann U, Wesch G, Grundlich E, Steinfensand RA: Mannheim Peritonitis Index, prediction of risk of death from peritonitis: Construction of a statistical and validation of an empirically based index. Theor Surg 1987;1:167–177.
  10. Billing A, Frohlich D, Schildberg FW, and the Peritonitis Study Group: Prediction of outcome using the Mannheim Peritonitis Index in 2003 patients. Br J Surg 1994;81:209–213.
  11. Farrell RJ, Farrell JJ, Morron MM: Diverticular disease in the elderly. Gastroenterol Clin North Am 2001;30:475–496.
  12. Wilson RG, Smith AN, Macintyre IMC: Complications of diverticular disease and non-steroidal anti-inflammatory drugs: A prospective study. Br J Surg 1990;77:1103–1104.
  13. Morris CR, Harvey IM, Stebbings WS, Speakman CT, Kennedy HJ, Hart AR: Anti-inflammatory drugs, analgesics and the risk of perforated colonic diverticular disease. Br J Surg 2003;90:1267–1272.
  14. Papagrigoriadis S, Macey L, Bourantas N, Rennie JA: Smoking is associated with complications of diverticular disease. Br J Surg 1999;86:923–926.
  15. Wedell J, Banzhaf G, Chaoui R, Fisher R, Reichman J: Surgical management of complicated colonic diverticulitis. Br J Surg 1997;84:380–383.
  16. Tudor RG, Farmakis N, Keighley MRB: National audit of complicated diverticular disease: Analysis of index cases. Br J Surg 1994;81:730–732.
  17. Belmonte C, Klas JV, Perez JJ, Wong WD, Rothenberger DA, Goldberg SM, Madoff RD: Hartmann procedure. First choice or last resort in diverticular disease? Arch Surg 1996;131:612–617.
  18. Corder AP, Williams JD: Optimal operative treatment in acute septic complications of diverticular disease. Ann R Coll Surg Engl 1990;72:82–86.
  19. Schilling MK, Maurer CA, Kollmar O, Buchler MW: Primary vs. secondary anastomosis after sigmoid colon resection for perforated diverticulitis (Hinchey stage III and IV). Dis Colon Rectum 2001;44:699–705.
  20. Blair NP, Germann E: Surgical management of acute sigmoid diverticulitis. Am J Surg 2002;183:525–528.
  21. Zeitoun G, Laurent A, Rouffet F, Hay J-M, Fingerhut A, Paquet J-C, Peillon C and the French Association for Surgical Research: Multicentre, randomised clinical trial of primary versus secondary sigmoid resection in generalized peritonitis complicating sigmoid diverticulitis. Br J Surg 2000;87:1366–1374.
  22. Biondo S, Jaurrieta E, Rague JM, Ramos E, Deiros M, Moreno P, Farran L: Role of resection and primary anastomosis of the left colon in the presence of peritonitis. Br J Surg 2000;87:1580–1584.
  23. Burns-Cox N, Campbell WB, van Nimmen BAL, Vercaeren PMK, Lucarotti M: Surgical care and outcome for patients in their nineties. Br J Surg 1997;84:496–498.
  24. Elliott TB, Yego S, Irvin TT: Five-year audit of acute complications of diverticular disease. Br J Surg 1997;84:535–539.
  25. Ambrosetti P: Invited Commentary. In Schilling MK, Maurer CA, Kollmar O, Bucher MK: Primary vs. secondary anastomosis after sigmoid colon resection for perforated diverticulitis (Hinchey stage II and IV). Dis Colon Rectum 2001;2001:699–705.
  26. Schoetz DJ Jr: Diverticular disease of the colon. A century-old problem. Dis Colon Rectum 1999;42:703–709.

Article / Publication Details

First-Page Preview
Abstract of Original Paper

Published online: May 11, 2005
Issue release date: May 2005

Number of Print Pages: 7
Number of Figures: 0
Number of Tables: 4

ISSN: 0253-4886 (Print)
eISSN: 1421-9883 (Online)

For additional information: https://www.karger.com/DSU


Copyright / Drug Dosage / Disclaimer

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.