ABSTRACT
OBJECTIVES: The aim of this study was to analyse the clinical course, surgical strategy and results in patients with complicated colonic diverticular disease. METHODS: We retrospectively compared two groups of patients who underwent surgery for complicated colonic diverticulosis from 1970 to 1984 (Group A, n = 94, mean age 60 years, 49 males, 45 females) and from 1985 to 1992 (Group B, n = 76, mean age 63.5, 32 males, 44 females). RESULTS: Patients in the two groups were comparable; only the rate of peritonitis (20 vs 8%) was different (p < 0.05). The most frequent operations in Group A were colostomy-drainage (43%) and Hartman's procedure (26%) in emergency situations and resection with immediate anastomosis (63%) or resection-anastomosis with diverting stomy (19%) in elective cases. In Group B, surgical strategy led to a different pattern of operations, 4 and 56% in emergency, and 94 and 2% in elective surgery, respectively. Overall mortality was 11%, with 17% and 4% in Groups A and B respectively (p < 0.01). This major drop in mortality was particularly important in emergency cases (31 vs 4%; p < 0.02). Morbidity in emergency surgery fell from 21 to 4% (P < 0.0006). Interrupting the use of colostomy-drainage was a major factor in reducing mortality followed by a sharp fall in mortality after Hartmann's procedure (28.5 vs 0%). CONCLUSION: The marked improvement in results between the two groups was mainly due to preferring resections of pathological colonic segments over colostomy-drainage.
Subject(s)
Abscess/etiology , Diverticulitis, Colonic/etiology , Diverticulum, Colon/complications , Intestinal Perforation/etiology , Sigmoid Diseases/etiology , Abscess/mortality , Abscess/surgery , Adult , Aged , Aged, 80 and over , Anastomosis, Surgical , Colostomy , Diverticulitis, Colonic/mortality , Diverticulitis, Colonic/surgery , Diverticulum, Colon/mortality , Diverticulum, Colon/surgery , Female , Gastrointestinal Hemorrhage/etiology , Gastrointestinal Hemorrhage/mortality , Gastrointestinal Hemorrhage/surgery , Humans , Intestinal Perforation/mortality , Intestinal Perforation/surgery , Male , Middle Aged , Peritonitis/etiology , Peritonitis/mortality , Peritonitis/surgery , Retrospective Studies , Sigmoid Diseases/mortality , Sigmoid Diseases/surgeryABSTRACT
Clinical and therapeutic characteristics of anorectal melanoma have been studied about 2 new cases. The initial symptoms were often misdiagnosed with hemorrhoids disease. This cancer carries a bad prognosis but the best treatment seems to be abdominoperineal resection (APR) when the thickness of the melanoma is under 3 mm. Over this limit, APR alone will not cure this disease. Curative treatment will probably involve a combined therapy with local and systemic therapies.
