scholarly journals Comparison Between Primary Resection Anastomosis and Hartmann Procedure for the Treatment of Hinchey III and IV Acute Diverticulitis in the Emergency Setting

2021 ◽  
Vol 31 (4) ◽  
pp. 300-308
Author(s):  
Marco Assenza ◽  
Gennaro Mazzarella ◽  
Sara Santillo ◽  
Greta Bracchetti ◽  
Edoardo De Meis ◽  
...  
Keyword(s):  
Acute Diverticulitis ◽  
Primary Resection ◽  
Emergency Setting ◽  
Hartmann Procedure

Primary resection and anastomosis for treatment of acute diverticulitis

1989 ◽  
Vol 32 (11) ◽  
pp. 933-939 ◽  
Author(s):  
Audencio Alanis ◽  
George K. Papanicolaou ◽  
Raafat R. Tadros ◽  
L. Peter Fielding
Keyword(s):  
Acute Diverticulitis ◽  
Primary Resection ◽  
Primary Resection And Anastomosis ◽  
Resection And Anastomosis

scholarly journals ACTUAL CLINICAL APPROACH FOR COMPLICATED DIVERTICULAR DISEASE IN GENERAL SURGERY DEPARTMENT

2018 ◽  
pp. 54-58
Author(s):  
B. K. Gibert ◽  
I. A. Matveev ◽  
N. A. Borodin ◽  
P. A. Zkhukov ◽  
A. N. Zakharova ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Diverticular Disease ◽  
General Surgery ◽  
Acute Diverticulitis ◽  
Daily Clinical Practice ◽  
Clinical Approach ◽  
Free Perforation ◽  
Hartmann Procedure ◽  
Surgery Department ◽  
Federal Guidelines

AIM. To revise clinical approaches for patients with complicated diverticular disease used in daily clinical practice in tertiary referral regional center and its compliance with Federal Guidelines. PATIENTS AND METHODS. Twenty-three patients with inflammatory complications of diverticular disease were treated in a General Surgery Department of Regional Hospital of Tumen City in 2015-2016. Preoperative ultrasound was performed for 19 (82.6%) patients, CT - only for 4 (17.4%), laparoscopy - for 13 (56.5%). Seven of them had uncomplicated acute diverticulitis and were treated conservatively. Sixteen (69.6°%) patients underwent Hartmann procedure. Five of them had phlegmonous diverticulitis, 10 - sealed perforation and only 1 - free perforation with fecal peritonitis. RESULTS. According to recent studies in diverticular disease, conservative approach had positive prognosis in 15 of 16 operated patients. All procedures included extended resections with an aim to remove not only inflamed segment of bowel but segments with multiple diverticula as well. Distal part of sigmoid colon was included in specimen in all cases. CONCLUSION. None of recommendations of Federal Guidelines was used in daily clinical practice for patients with diverticular disease and indications for surgery were unreasonably extended in majority of cases. A juridical status of Federal Clinical Recommendations should be increased.

Surgical Treatment of Diverticulitis

2019 ◽  
Author(s):  
Tiffany K Weidner ◽  
John T Kidwell ◽  
David A Etzioni
Keyword(s):  
Surgical Treatment ◽  
Diverticular Disease ◽  
Primary Anastomosis ◽  
Acute Diverticulitis ◽  
Sigmoid Resection ◽  
Hartmann Procedure ◽  
Laparoscopic Lavage ◽  
Uncomplicated Diverticulitis ◽  
Recurrent Diverticulitis ◽  
Purulent Peritonitis

Surgical evaluation and treatment is commonly required for the treatment of diverticulitis in both the acute and elective situations. This chapter discusses the surgical treatment of the clinically important manifestations of diverticular disease. Different options for surgical treatment are described for patients in both the urgent and elective settings, including technical aspects of these options. Current controversies are reviewed, including resection versus laparoscopic lavage for the treatment of purulent peritonitis, the use of gastrointestinal diversion in the surgical treatment of acute diverticulitis, and timing of operation for recurrent diverticulitis.  This review contains 8 figures, 4 tables, and 67 references. Key Words: acute diverticulitis, complicated diverticulitis, diverticular disease, diverticulitis, diverticulosis, Hartmann procedure, laparoscopic lavage, sigmoid resection with primary anastomosis, uncomplicated diverticulitis

scholarly journals EP.FRI.815 Hartmann’s at 100: Relevant or Redundant?

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Nicholas Frakas ◽  
Michael Conroy ◽  
Holly Harris ◽  
Ross Kenny ◽  
Mirza Baig
Keyword(s):  
Colorectal Cancer ◽  
Hospital Admissions ◽  
Acute Diverticulitis ◽  
Day Surgery ◽  
Benign Disease ◽  
Hartmann’S Procedure ◽  
Emergency Setting ◽  
Rectosigmoid Colon ◽  
Hartmann's Procedure ◽  
Effective Option

Abstract Introduction Henri Albert Hartmann first described resection of the rectosigmoid colon and exteriorization of the bowel with a colostomy in 1921. As we approach the centenary anniversary of Hartmann’s procedure we feel it is the appropriate time to discuss this significant surgical advancement and its relevance in modern day surgery.    Methods We provide a contemporary overview of the literature, highlighting various aspects of the Hartmann’s procedure applicable to both today’s clinical practice and that of tomorrow. Results Hartmann’s procedure was initially performed for colorectal carcinoma in 1921. One hundred years on, the Hartmann’s procedure remains a safe and effective option in select patients with colorectal cancer and at high risk of anastomotic failure. In recent years, the majority of Hartmann’s procedures have been performed for benign disease and the majority of these cases are in the emergency setting. As hospital admissions with acute diverticulitis continue to rise steeply, the importance of the Hartmann’s procedure in the field of surgery continues. Hartmann’s procedure has adapted as surgery has advanced. Hartmann’s is now performed both laparoscopically and robotically with good postoperative outcomes.   Conclusions In 1921, few would have predicted how modern day medicine and surgery is today. Hartmann’s procedure has survived the surgical test of time, and its key principles remain the same. As we look to the future, it is unlikely that it’s role will be lost to surgical advances, but to alternative management modalities in disease prevention.  

scholarly journals Complicated diverticular disease: the changing paradigm for treatment

2012 ◽  
Vol 39 (4) ◽  
pp. 322-327 ◽  
Author(s):  
Abe Fingerhut ◽  
Nicolas Veyrie
Keyword(s):  
Diverticular Disease ◽  
Bed Rest ◽  
Minimal Invasive ◽  
Primary Resection ◽  
Hartmann’S Procedure ◽  
Hartmann Procedure ◽  
Laparoscopic Lavage ◽  
Hartmann's Procedure ◽  
Therapeutic Algorithms ◽  
Purulent Peritonitis

The term "complicated" diverticulitis is reserved for inflamed diverticular disease complicated by bleeding, abscess, peritonitis, fistula or bowel obstruction. Hemorrhage is best treated by angioembolization (interventional radiology). Treatment of infected diverticulitis has evolved enormously thanks to: 1) laparoscopic colonic resection followed or not (Hartmann's procedure) by restoration of intestinal continuity, 2) simple laparoscopic lavage (for peritonitis +/- resection). Diverticulitis (inflammation) may be treated with antibiotics alone, anti-inflammatory drugs, combined with bed rest and hygienic measures. Diverticular abscesses (Hinchey Grades I, II) may be initially treated by antibiotics alone and/or percutaneous drainage, depending on the size of the abscess. Generalized purulent peritonitis (Hinchey III) may be treated by the classic Hartmann procedure, or exteriorization of the perforation as a stoma, primary resection with or without anastomosis, with or without diversion, and last, simple laparoscopic lavage, usually even without drainage. Feculent peritonitis (Hinchey IV), a traditional indication for Hartmann's procedure, may also benefit from primary resection followed by anastomosis, with or without diversion, and even laparoscopic lavage. Acute obstruction (nearby inflammation, or adhesions, pseudotumoral formation, chronic strictures) and fistula are most often treated by resection, ideally laparoscopic. Minimal invasive therapeutic algorithms that, combined with less strict indications for radical surgery before a definite recurrence pattern is established, has definitely lead to fewer resections and/or stomas, reducing their attendant morbidity and mortality, improved post-interventional quality of life, and less costly therapeutic policies.

scholarly journals An Uncommon Cause of Acute Abdominal Pain: Primary Epiploic Appendagitis in the Emergency Setting

2017 ◽  
Vol 31 (1&2) ◽  
pp. 17
Author(s):  
Scott D. Casey ◽  
Joseph DiVito Jr. ◽  
Jason B. Lupow ◽  
Reshma Gulani
Keyword(s):  
Computed Tomography ◽  
Abdominal Pain ◽  
Emergency Physician ◽  
Acute Abdominal Pain ◽  
Acute Diverticulitis ◽  
Emergency Setting ◽  
Imaging Studies ◽  
Epiploic Appendagitis ◽  
Medical Interventions

In the emergency setting, the diagnosis of benign causes of acute abdominal pain can prevent unnecessary medical interventions. To illustrate this point, we report the case of a 28-year-old man who presented to the emer- gency department with symptoms suggestive of acute diverticulitis. Abdominal computed tomography (CT) established, instead, a diagnosis of primary epiploic appendagitis (PEA), which was managed expectantly. The patient’s symptoms resolved within one week of hospital discharge and he remained free of pain at a five-month phone follow-up. Increased awareness of PEA and its self-limited course can help the emergency physician avoid unnecessary imaging studies and expectantly manage this cause of acute abdominal pain. 

Clinical Practice in the Psychiatric Emergency Setting

1984 ◽  
Vol 29 (1) ◽  
pp. 61-62
Author(s):  
Lyn A. De Amicis
Keyword(s):  
Clinical Practice ◽  
Psychiatric Emergency ◽  
Emergency Setting

Bedside Cardiac Pocus in Emergency Setting: A Practice Review

2020 ◽  
Vol 15 ◽  
Author(s):  
Christian Zanza ◽  
Yaroslava Longhitano ◽  
Marco Artico ◽  
Gianmaria Cammarota ◽  
Andrea Barbanera ◽  
...  
Keyword(s):  
Emergency Medicine ◽  
Core Curriculum ◽  
Case Reports ◽  
Short Review ◽  
Rapid Identification ◽  
Cochrane Library ◽  
Emergency Setting ◽  
Holistic View ◽  
Questions And Answers ◽  
The Usa

Background: in the last years, ultrasound technology has entered in clinical practice as a tank and today, it has also allowed to no-cardiologists to extend and to deep their medical examination without the needing to call the consultant and having a good profile of diagnostic accuracy. The ultrasound bedside does not replace the consultant but it allows not to perform inappropriate consultations with more savings for hospitals. Objective: The aim was to review recently published literature to inform the clinician about the most up to date management of use bedside echography in emergency setting. In this short review we focused on two types of syndromes, no traumatichypotension and dyspnea, common to the three holistic disciplines of medicine, showing the main and basic questions and answers that ultrasound can give us for rapid identification of the problem Methods: We conducted a systematic review using Pubmed/Medline, Ovid/Willey and Cochrane Library, combining key terms such as “cardiac ultrasound, “cardiac diseases”,“emergency medicine”,“pocus”, “dyspnea”,“ hypotension”. We selected the most relevant clinical trials and review articles (excluding case reports) published in the last 19 years and in our opinion 59 publications appeared the best choice according to the PRISMA statement. In additional papers identified from individual article reference lists were also included. Conclusion: Recent studies have shown promise in establishing best practices for evaluation of heart, lung abdomen and deep vessels At the moment bedside US is widely used in an integrated ultrasound vision just like the holistic view have internal medicine, intensive care and emergency medicine and many medical schools in Europe and the USA are inserting ultrasonography into the core curriculum but we still have to find a standard method for the training program for minimum competence acquisition.

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