The conditions and characteristics of these patients were Selleck Sapanisertib comparable to those of the primary anastomosis patients, yet the former group experienced poorer clinical outcomes than the latter. In the event of either intraoperative difficulty or extraperitoneal anastomosis,
a diverting loop ileostomy following resection and primary anastomosis ,may suggested for high-risk patients who are hemodynamically stable; in this case, high risk is defined by immunosuppression, fecal peritonitis, and/or ASA grade IV . Masoomi et al.  using the National Inpatient Sample database, examined the clinical data of patients who underwent an urgent open colorectal resection (sigmoidectomy or anterior resection) for acute diverticulitis from 2002 to 2007 in the United States. A total of 99,259 patients underwent urgent surgery for acute diverticulitis during these years [Primary anastomosis without diversion: 39.3%; Hartman's PF-02341066 clinical trial procedure (HP): 57.3% and primary anastomosis with proximal diversion (PAD): 3.4%]. The overall complication rate was lower in the PAD group compared with the HP group (PAD: 39.06% vs. HP: 40.84%; p = 0.04). Patients in the HP group had a shorter mean length of stay (12.5 vs.14.4
days, p < 0.001) and lower mean hospital costs (USD 65,037 vs. USD 73,440, p < 0.01) compared with the PAD PD0332991 datasheet group. Mortality was higher in the HP group (4.82 vs. 3.99%, p = 0.03). PAD improved outcomes compared with HP, and should be considered in patients who are deemed candidates for two-stage operations for acute diverticulitis. Laparoscopic peritoneal lavage with placement of drainage tubes is a safe approach for cases of perforated
diverticulitis (Recommendation 2B). Several case series and prospective studies have demonstrated that laparoscopic peritoneal lavage Dimethyl sulfoxide is a safe alternative to conventional management in the treatment of perforated diverticulitis with diffuse purulent peritonitis [76–79]. Recently a retrospective population study used an Irish national database to identify patients acutely admitted with diverticulitis, was published. Demographics, procedures, comorbidities, and outcomes were obtained for the years 1995 to 2008 . Two thousand four hundred fifty-five patients underwent surgery for diverticulitis, of whom 427 underwent laparoscopic lavage. Patients selected for laparoscopic lavage had lower mortality (4.0% vs 10.4%, p < 0.001), complications (14.1% vs 25.0%, p < 0.001), and length of stay (10 days vs 20 days, p < 0.001) than those requiring laparotomy/resection. Patients older than 65 years were more likely to die (OR 4.1, p < 0.001), as were those with connective tissue disease (OR 7.3, p < 0.05) or chronic kidney disease (OR 8.0, p < 0.001). Colonic carcinoma perforation Patients with perforated colonic carcinoma represent the highest risk cases of colonic perforation .