Damage Control Surgery in Different Surgical Specialties

*Trauma and Emergency Surgery - The Role of Damage Control Surgery*

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**Chapter 5**

**Abstract**

**1. Introduction**

acute diverticulitis (CAD) [1–3].

Damage Control in Hinchey III

and IV Acute Diverticulitis

*Andrea A. Casamassima, Fernando Gallego Estrada,* 

*Diego Mariani, Olga Marin Casajús, Matteo Marconi,* 

*Nuno Filipe Muralha Antunes, Laura María Pradal Jarne,* 

Acute diverticulitis is one of the most common surgical causes of admission to Emergency Departments in Western Countries. Although most of the cases can be managed conservatively or electively, a number of them will require an emergency surgical treatment. Among these patients, an even smaller number of them will present with a full-blown catastrophic septic shock. These minorities of cases have accounted for a significant part of the overall mortality and morbidity of complicated acute diverticulitis itself. The implementation of Damage Control strategies has shown to be useful also in these septic catastrophes, where a profound derangement of physiology makes unsafe a classic approach. Damage Control, as we intend it, is not a surgical "technique." A close collaboration between different specialties brought forth a strategy of treatment. The Surgeon, the Anesthetist, and the Intensivist are the three most involved specialists in the treatment of these cases. It is paramount for them to learn how to work side by side and in harmony, since the

**Keywords:** acute diverticulitis, damage control, peritonitis, laparostomy, Sepsis

Diverticular disease is a common and increasing cause of emergency consultation in Western countries with 3–5 cases per 100,000 habitants. Although in most cases it remains asymptomatic, roughly 20% may require emergency treatment. The advances both in image quality of new multi-slice CT scans and laparoscopic procedures have influenced changes in the way we treat these complicated patients. Complications of sigmoid diverticulitis due to acute inflammation and colonic wall perforation may manifest as pericolic (Hinchey I) or extra-mesocolic (Hinchey II) abscesses, and purulent (Hinchey III) or fecal peritonitis (Hinchey IV). Although the first two are managed conservatively, treatment for stages III/IV is not that straightforward. We will refer to Hinchey III/IV acute diverticulitis as complicated

*Alessandro Garcea, Ioannis Gerogiannis, Alberto Lafita López,* 

*Luca Ponchietti, Néstor Bueno Vidales,* 

*Jorge Vera Bella and Carlos Yánez Benítez*

patients will benefit from each-one's input in their care.
