OUTCOME OF DIFFUSE FECAL AND PURULENT PERITONITIS FOLLOWING COLONIC PERFORATION

The mortality from faecal or purulent peritonitis following colonic perforation has been reported to be between 15 and 40%. These reports extend over many years and cannot take into account the influence of modem intensive care or a standardized surgical approach. In the past 3 years 121 patients (75% over 60 years of age) presented to our institution with colonic perforation. Fifteen patients had a diffuse purulent peritonitis and a further 13 patients faecal peritonitis. The cause of perforation and peritonitis was in 17 cases diverticular disease, in 8 a carcinoma, in 2 colitis, and in 1 case an endoscopic perforation. Ninety-four percent of the patients with purulent peritonitis underwent a Hartmann procedure as the primary operation. In those patients with faecal peritonitis 60% underwent a Hartmann procedure and 34% a similar procedure modified by the site of perforation. The overall 30-day mortality was 7.5% (8/121); in the group with diffuse peritonitis it was 10.5%. Patients with diffuse peritonitis had a much higher risk of complications (60%) than patients with local peritonits (30%). We believe that the low mortality rate was due to improved intraoperative and postoperative management (fluid balance and routine antibiotic regime) following a standardized surgical approach. There was a significant morbidity in 60% of the patients.