Perforated diverticulitis in a Hartmann rectal pouch.

The Hartmann procedure is the surgical treatment of choice for perforated diverticulitis. Modifications leaving a long rectal pouch or mucous fistula and a variable length of bowel that contains inactive diverticula have been described. A steroid-dependent patient presented with perforated diverticulitis in residual disease in the Hartmann rectal pouch ten months after initial sigmoid resection for a perforated diverticulum. Because steroid-treated patients are at high risk for complications and recurrent disease, all diseased bowel should be resected during the initial procedure.