The surgical management of diverticular disease of the colon complicated by perforation.

Thirty instances of perforating diverticulitis seen at the University of Alabama Hospital were retrospectively reviewed. The correct diagnosis was assumed prior to operation in only 12. A palpable mass located in the lower part of the abdomen was found in 15 patients. All of the patients had a pericolic type of perforation. Seven patients, five with symptoms highly suggestive of a diverticular disease of the colon, were operated upon for suspected gynecologic problems. It appears that the patients in this group could have been treated more appropriately if the diagnosis of a perforating diverticulitis had been considered preoperatively. It is important to determine whether or not the perforation is pericolic, intramesenteric or free, with spreading peritonitis, since the advocated treatment is different for each type of perforation observed.