Annals of Coloproctology

Original Article

Benign GI diease

Prognostic Factors and Management for Left Colonic Perforation: Can Hartmann’s Procedure Be Preventable?: Yilseok Joo, Yujin Lee, Taeyoung Yoo, Jungbin Kim, Inseok Park, Geumhee Gwak, Hyunjin Cho, Keunho Yang, Kiwhan Kim, Byung-Noe Bae; Ann Coloproctol. 2020;36(3):178-185. Published online June 30, 2020; DOI: https://doi.org/10.3393/ac.2019.11.14.1

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Purpose
To identify factors significantly associated with the mortality of patients with left colonic perforation, and to compare the outcome of Hartmann’s procedure (HP) and primary repair (PR) or primary anastomosis (PA) in patients with left colonic perforation without factors associated with mortality.
Methods
This retrospective study included patients who underwent surgery for left colonic perforation from January 2009 to February 2018. Preoperative factors related to postoperative mortality, including vital signs, laboratory findings, and intraoperative findings, were analyzed by type of operation. The chi-square, Fisher exact, and Mann-Whitney U-tests were used to analyze the data.
Results
Ninety-one patients were included (36 men, 55 women), and 15 (16.5%) died postoperatively. Prognostic factors were age, leukopenia, thrombocytopenia, bleeding tendency, acute kidney injury, hemodynamic instability, and the existence of feculent ascites. Leukopenia and longer operative time were independent risk factors for mortality. Seventy-nine patients did not have leukopenia and 30 of these patients who underwent PR without diversion were excluded from the subanalysis. HP was performed in 30 patients, and PR with diversion and PA with or without diversion were performed in 19. Compared to the other operative methods, HP had no advantage in reducing hospital mortality (P=0.458) and morbidity.
Conclusion
Leukopenia could be an objective prognostic factor for left colonic perforation. Although HP is the gold standard for septic left colonic perforation, it did not improve the hospital mortality of the patients without leukopenia. For such patients, PR or PA may be suggested as an alternative option for left colonic perforation.

Citations

Citations to this article as recorded by

Risk Factors for Postoperative Major Morbidity, Anastomotic Leakage, Re-Surgery and Mortality in Patients with Colonic Perforation
Maximilian Brunner, Lara Gärtner, Andreas Weiß, Klaus Weber, Axel Denz, Christian Krautz, Georg F. Weber, Robert Grützmann
Journal of Clinical Medicine.2024; 13(17): 5220. CrossRef
Evaluation of Morbidity and Mortality in Iatrogenic Colonic Perforation During Colonoscopy: A Comprehensive Systematic Review and Meta-Analysis
Ajibola A Adebisi, Daniel E Onobun, Adeola Adediran, Reginald N Ononye, Ethel O Ojo, Adedayo Oluyi, Ayotunde Ojo, Stephen Oputa
Cureus.2024;[Epub] CrossRef
Patient outcomes and prognostic factors associated with colonic perforation surgery: a retrospective study
Do-bin Lee, Seonhui Shin, Chun-Seok Yang
Journal of Yeungnam Medical Science.2022; 39(2): 133. CrossRef
Morbidity and Mortality of Neutropenic Patients in Visceral Surgery: A Narrative Review
Ann-Kathrin Lederer, Fabian Bartsch, Markus Moehler, Peter Gaßmann, Hauke Lang
Cells.2022; 11(20): 3314. CrossRef

Original article

WITHDRAWN: Risk factors and management for left colonic perforation: Yilseok Joo, Yujin Lee, Taeyoung Yoo, Jungbin Kim, Inseok Park, Geumhee Gwak, Hyunjin Cho, Keunho Yang, Kiwhan Kim, Byung-Noe Bae; Received September 2, 2019 Accepted November 14, 2019 Published online January 31, 2020; DOI: https://doi.org/10.3393/ac.2019.11.14

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Original Article

Predictive Factors Affecting the Clinical Course of Patients With Diverticulitis: Who Needs Hospital Management?: Taeyoung Yoo, Keun Ho Yang, Jungbin Kim, Inseok Park, Hyunjin Cho, Geumhee Gwak, Byung Noe Bae, Ki Hwan Kim; Ann Coloproctol. 2018;34(1):23-28. Published online February 28, 2018; DOI: https://doi.org/10.3393/ac.2018.34.1.23

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98 Download
5 Web of Science
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Abstract PDF

Purpose

The aim of this study is to determine the predictable factors that affect the clinical course, especially the hospital stay, the operation performed, and to determine factors that will be helpful in deciding whether in-hospital or outpatient treatment is appropriate.

Methods

We retrospectively collected medical data for patients who had been diagnosed with acute diverticulitis at Inje University Sanggye Paik Hospital between January and December 2016. In total, 117 patients were enrolled in this study. We examined clinical factors, including age, sex, body mass index, pain, body temperature, white blood cell count, C-reactive protein, nil per os (NPO) time, hospital duration, computed tomography (CT) findings, location of diverticulitis, operation performed, and presence of comorbidity (e.g., hypertension and diabetes mellitus).

Results

In the multivariate analysis, the statistically significant factor related with hospital duration was the presence of perforation on the CT scan (P < 0.001). Longer NPO time was related with pain score (>7) (P = 0.011). Operations were mainly performed in patients with left-sided colonic diverticulitis (P = 0.012).

Conclusion

We suggest a perforation finding on the CT scan, a severe pain score at least above 7 on a numeric rating pain scale, and a left-sided lesion are absolute indications for in-hospital management.

Citations

Citations to this article as recorded by

Epidemiology, Management, and Outcomes of Acute Diverticulitis in King Abdul-Aziz University Hospital, Jeddah, Saudi Arabia
Hanan M Bamanie, Nadim Malibary, Nada A Algarni, Jumana O Badawi, Lujain M AlNasser, Khadijah A Almalki, Renad F Alnemari
Cureus.2022;[Epub] CrossRef
Development of a prediction model for clinically important outcomes of acute diverticulitis
Stephen Gyung Won Lee, Sang Do Shin, Hui Jai Lee, Gil Joon Suh, Do Joong Park
The American Journal of Emergency Medicine.2021; 50: 27. CrossRef
Diverticulitis: An Update From the Age Old Paradigm
Alexander T. Hawkins, Paul E. Wise, Tiffany Chan, Janet T. Lee, Tamara Glyn, Verity Wood, Timothy Eglinton, Frank Frizelle, Adil Khan, Jason Hall, M.I. Mohammed Ilyas, Maria Michailidou, Valentine N. Nfonsam, Michelle L. Cowan, Jennifer Williams, Scott R.
Current Problems in Surgery.2020; 57(10): 100862. CrossRef
Is the outpatient management of acute diverticulitis safe and effective? A systematic review and meta-analysis
R. Cirocchi, J. J. Randolph, G. A. Binda, S. Gioia, B. M. Henry, K. A. Tomaszewski, M. Allegritti, A. Arezzo, R. Marzaioli, P. Ruscelli
Techniques in Coloproctology.2019; 23(2): 87. CrossRef
Clinical presentation and outcomes of acute diverticulitis in a Middle Eastern population
Jasim Alabbad, Fawaz Abdul Raheem, Saba Al-Saddah, Abdulaziz Al-Mubarak
Arab Journal of Gastroenterology.2019; 20(2): 99. CrossRef

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