Abstract
Diverticulitis manifestations may cover a spectrum of mild local inflammation to diffuse
feculent peritonitis. Up to 35% of patients presenting with diverticulitis will have
purulent (Hinchey grade III) or feculent (Hinchey grade IV) contamination of the abdomen,
with a high-associated morbidity and mortality. Surgical management may involve segmental
resection with or without restoration of bowel continuity. However, emergency resection
for diverticulitis can be associated with high mortality rates, as well as low stoma
reversal rates at 1 year. Therefore, laparoscopic peritoneal lavage has been proposed
for use in selected patients with purulent peritonitis. The topic of laparoscopic
peritoneal lavage for the treatment of perforated diverticulitis in the literature
has been controversial. Our review of the recent data show that laparoscopic lavage
may be safe and feasible in select patients with similar rates of mortality and major
morbidity. There is, however, a concern regarding an associated higher rate of postoperative
abscess and early reintervention risk.
Keywords
diverticulitis - laparoscopic peritoneal lavage - perforated diverticulitis - purulent
peritonitis
