2
28
PETERS ET AL.
DISCUSSION
ual diverticula was not established. In a group
of 147 patients undergoing elective resection,
To our knowledge a case of diverticulitis with between 1957 and 1975, no patient required a
stomal perforation into the subcutaneous tissue second operation [1]. Patients’ age and mortal-
has not been described before. Reporting this ity, however, were not mentioned in that study.
case is valuable because of its rarity, the initial These findings nevertheless suggest that the in-
diagnostic problems, and the dilemmas faced in cidence of recurrence is low.
the approach to residual diverticula in patients
A recurrence rate of 8% was reported in a re-
previously operated for perforated diverticulitis. cent study on clinical and functional results
The diagnostic problems have general and after resection for diverticular disease [6]. Func-
local aspects. The dyspnea and chest pain ap- tional bowel symptoms were more often present
peared to be signs of sepsis secondary to a lo- in elderly patients, and were associated with a
cal infection. Severe obesity probably aggra- lower satisfaction score. Patients younger than
vated her pulmonary problems. The phlegmon 60 years had a significantly better outcome. Un-
was mistakenly diagnosed as infection sec- fortunately, recurrence rate related to age was
ondary to a skin lesion related to stoma adhe- not assessed. In younger patients, more ex-
sives. Stomal leakage in particular may con- tended surgery may be warranted because of
tribute to the development of a phlegmon, greater life expectancy, better physical condition
although this is associated mainly with small [5–7] and the expectation of better outcomes. We
bowel enterostomies.
have initiated a large retrospective follow-up
Ultrasound did not reveal a parastomal ab- study of patients operated on for diverticulitis
scess. This diagnostic tool, however, is less ac- in order to define the risk of recurrent divertic-
curate when applied in the region of an en- ulitis and the optimal surgical strategy.
terostomy because of air in the intestine. In
retrospect, we believe that an abscess was
present at the time of admission based on the
clinical course and findings at laparotomy.
Residual diverticula in the remaining colon
were diagnosed previously in this patient, but
were not treated. This is understandable consid-
ering her general condition at that time, her age,
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2
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[
2]. It is estimated that 10–25% of people with
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2
002;183:7–11.
are not easily defined since patients who previ-
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7
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Address reprint requests to:
Dr. H. van Goor
There are hardly any data on recurrent di-
verticulitis after previous surgical manage-
ment. Moreaux [5] reported 3% of patients with
recurrence of diverticular disease after surgery
for diverticulitis and 11% with persistent symp-
toms. A relation of the symptoms with resid-
Department of Surgery
University Medical Center, Nijmegen
P.O. Box 9101
6500 HB Nijmegen, The Netherlands