Acute Perforated Diverticulitis of the Sigmoid Colon with Generalized Peritonitis

Acute free perforation of a diverticulum of the sigmoid with generalized peritonitis is a rare complication of diverticulitis. Arnheim¹ in reviewing 834 cases of surgically treated diverticulitis from the literature found that 19% of cases had abscess formation, 12% had localized peritonitis, and only 2% had spreading peritonitis. The very nature of the inflammatory process in diverticulitis of the sigmoid is in essence a peridiverticulitis. This promotes dense adhesions to surrounding structures, such as small bowel, bladder, cecum, and other segments of sigmoid at an early phase in the inflammatory process, with resultant abscess and fistula formation but rarely with free perforation to the peritoneal cavity with generalized peritonitis.² Maingot⁶ states that the seriousness of this rare complication of diverticulitis requires prompt surgical definitive intervention in order to lessen the high mortality rate from such a lesion. At the Riverside Medical Clinic in the past five years