Surgical treatment of acute perforative sigmoid diverticulitis

Various methods of management of perforative sigmoid diverticulitis with diffusing peritonitis have been evaluated. It is suggested that the three-stage procedure with initial drainage and proximal colostomy in common use today should be abandoned. Consideration should be given only to procedures that eliminate the perforated loop of bowel from the peritoneal cavity at the initial operation. Twelve consecutive cases of acute perforative sigmoid diverticulitis with diffusing peritonitis are presented in which the first stage consisted of exteriorization of the perforated loop of sigmoid followed by subsequent partial left colectomy at a five-or six-week interval. There were no deaths and very little morbidity. We believe this to be the simplest, safest, and surest way of managing this complication of sigmoid diverticulitis.