Traditionally, surgical sigmoid diverticular emergencies used to be treated in stages, but more recently there has been a trend towards definitive surgery with immediate resection plus @entity254 under certain conditions. The aim of this study was to define the morbidity and mortality of resection plus @entity254 with on-table antegrade irrigation and of the Hartmann procedure for complicated sigmoid @entity4436 in relation to the type of @entity298 and to the American Society of Anesthesiologists (ASA) grade of the @entity1 . From April 1999 to April 2002, 38 emergency operations for complicated sigmoid @entity4436 were performed at the San Sebastiano Hospital in Caserta. Six @entity1 underwent operations for obstructions and 32 for perforation (19 Hinchley stage III and 13 Hinchley stage IV). Surgical therapy for obstruction consisted in 4 resections plus @entity254 , 1 subtotal colectomy and 1 Hartmann procedure. Surgical therapy for perforation consisted in 14 resections plus @entity254 and 18 Hartmann procedures. There was 1 case (5%) of anastomotic dehiscence out of 19 primary anastomoses versus 2/19 surgical complications (10%) after the Hartmann procedure. The mortality amounted to 1 death out of 38 (2.6%) in a @entity1 treated with the Hartmann procedure. Left-sided @entity694 should be treated by resection plus @entity254 or by subtotal colectomy for ASA II-III @entity1 and by Hartmann's procedure for ASA IV-V @entity1 . ASA II-III @entity1 with localised or generalised @entity298 should be treated by resection plus @entity254 , while a Hartmann procedure should be the reasonable option for generalised @entity298 and for ASA IV-V @entity1 with localised or generalised @entity298 .

[Surgical treatment of complicated sigmoid XXXX : our experience].

@entity1 :: ('9606', 'Species') :: ['patients', 'patient'] @entity254 :: ('MESH:C563598', 'Disease') :: ['anastomosis'] @entity4436 :: ('MESH:D004238', 'Disease') :: ['diverticulitis'] @entity694 :: ('MESH:D003110', 'Disease') :: ['colonic obstruction'] @entity298 :: ('MESH:D010538', 'Disease') :: ['non-faecal peritonitis', 'faecal peritonitis', 'peritonitis']
@entity4436 :: (MESH:D004238,Disease) :: ['diverticulitis']
