Surgical management of colonic diverticulosis with massive hemorrhage by subtotal colectomy: report of two cases

Emergency abdominal colectomy with primary anastomosis

From 1968 to 1979, 18 patients underwent emergency abdominal colectomy with ileorectal anastomosis. Indications for operation included massive colonic bleeding (11), obstructing carcinoma (5), toxic megacolon (1), and enterocolitis (1). Five patients died postoperatively (27.8 per cent). Causes of death included sepsis, upper gastrointestinal bleeding, and respiratory failure. All had peritonitis, and five had documented anastomotic leaks. Seven of the surviving patients had significant morbidity from the procedure which included anastomotic leak, small bowel obstruction, wound infection, sepsis, and pulmonary emboli. Only six patients survived without complications. Although others have written about the safety of emergency subtotal colectomy with ileorectal anastomosis, our experience suggests this procedure is associated with excessive morbidity and mortality.

Emergency subtotal colectomy: preferred approach to management of massively bleeding diverticular disease

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Massive hemorrhage for diverticulosis of the colon: guidelines for therapy based on bleeding patterns observed in fifty cases

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