A CASE OF MULTIPLE DIVERTICULAR DISEASES OF THE LARGE INTESTINE ACCOMPANIED BY SIGMOID DIVERTICULAR PERFORATION

Abstract

A 57-year-old male with a brief history of fever and right lower quadrant pain was referred to our clinic. He was diagnosed as having acute appendicitis. Laparotomy revealed cecal diverticulitis with local peritonitis. Appendectomy and peritoneal drainage were performed. On the third postoperative day, fecaloid discharge was obtained from the drainage tube. Fistelography confirmed perforation of the sigmoidal diverticulum. The patient had been treated conservatively with general antibiotics and low residual diet. Six weeks later, the diverticular perforation was found to be cured and he was discharged. After 3 months, he was re-admitted because of severe abdominal pain. Emergency celiotomy revealed panperitonitis due to diverticular perforation of the sigmoid colon and leveling transverse colostomy was made. He was treated successfully by a two stage operation, resection of the sigmoid colon and closure of the colostomy. Our experience in this case suggests that conservatively treated perforated diverticulum in the left colon has high risk of re-perforation, so early definitive surgery is indicated.