Laparoscopic lavage and drainage for Hinchey III diverticulitis: Is it as bad as it sounds?

Abstract text (incl. references and figure legends)

Case history:A 42-year-old obese man went to the emergency department for non-persistent and aggravating abdominal pain with 3 days of evolution, located in the hypogastrium and LIF, accompanied by nausea and fever. He denied other symptoms.Clinical findings:At physical exam, he had pain at deep palpation, at decompression, and tenderness over the hypogastrium and LIF. No renal murphy sign was present.Results and Diagnosis:An elevation of inflammatory parameters was present;renal function was normal.A CT scan showing inflamed sigmoid diverticular sacs, with liquid on the Douglas fossa and an abscess next to spleen, confirmed the diagnosis of acute diverticulitis Hinchey II.Therapy and Progression:Antibiotic and proper analgesia was initiated, with improvement of the patient. 2 days later, he got hypotensive, tachycardic, with uncontrolled pain; a proper optimization was started. A CT scan was asked, revealing free air and liquid next to inflamed sigmoid colon (Hinchey III). It was proposed a laparoscopic drainage and lavage of the abdomen with the possibility of ending in a Hartman procedure. Generalized purulent content was found in laparoscopy, with no perforation spot or faecaloid peritonitis; collections were drained, and an extensive lavage of the abdomen was made; abdominal drains were left. The patient got better and was discharged, with the usual recommendations. A total colonoscopy after the surgery showed sigmoid diverticular sacs. After discussing options, it was decided to perform a watch and wait approach with the patient remaining asymptomatic.Comments:Laparoscopic lavage and drainage is suggested in selected patients with generalized purulent peritonitis, allowing preservation of sigmoid colon and avoidance of a stoma, especially in young patients.References: Sartelli, M., Weber, D.G., Kluger, Y. et al. 2020 update of the WSES guidelines for the management of acute colonic diverticulitis in the emergency setting. World J Emerg Surg 15, 32 (2020).

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