A Case of Laparoscopic Hartmann's Procedure Followed by Laparoscopic Reversal for Perforated Diverticulitis

Abstract

A man in his 60s was referred to our hospital with a diagnosis of perforated diverticulitis in the sigmoid colon. Emergency surgery was indicated for his Hinchey grade Ⅲ diverticulitis and he underwent laparoscopic Hartmann ʼ s procedure. The postoperative course was uneventful and he was discharged without complications. He was then scheduled for laparoscopic Hartmann ʼ s reversal at 4 months after the initial surgery. The surgical procedure consisted of takedown of colostomy, adhesiolysis and end-to-side colorectal anastomosis using the same ports placed during the initial surgery. The postoperative course was uneventful and he was discharged without complications. Although the efficacy and safety of laparoscopic Hartmann ʼ s procedure for perforated diverticulitis and subsequent laparoscopic reversal has recent-ly been demonstrated in the literature, there were few reports from Japan. The optimal surgical approach for perforated diverticulitis must be discussed considering the patient ʼ s condition, Hinchey classification, and availability of cooperative medical staff including surgical expertise.