Abstract
The following six patients were studied by me while
I was conducting a Pilot Survey into the natural history
of Diverticular Disease of the Colon. This survey was
carried out at the Western General Hospital, Edinburgh,
during the Summer of 1961+ while I was the holder of a
Gunning Vacation Bursary, tenable in the Department of
Surgery. Accordingly I am grateful to the surgeons of
the Western General Hospital for allowing me access to
their patients; and to Sir John Bruce and Mr. C.W.A.
Falconer for their personal encouragement during this
project.
The patients whom I have selected are not intended to
paint the general picture of diverticular disease as it is
found within the community at large - they are chosen rather
to provide illustrations at the extreme surgical end of the
spectrum of this disease. Such an approach seemed
justifiable since, while it still remains true that 70% of
patients with diverticular disease will be maintained in
good health by simple medical measures, the pendulum of
clinical opinion is swinging rapidly towards earlier
surgical intervention in the remaining 30% of patients.
The "Discussion" on the patients will not be completed
in the manner which is conventional at the Finals
Examination where great emphasis must be placed upon
"Differential Diagnosis" and "Prognosis" for each patient.
This variation in technique was considered advisable since
in all six patients the diagnosis had been established with
certainty - indeed, in 3 cases I personally had the
opportunity to examine the resected colon - and it appeared
to me that retrospective analysis of the presenting features
for the sole purpose of fabricating an extensive
differential diagnosis would be both futile and dishonest.
Furthermore, the 3 patients who had not died during their
initial hospital admission had been studied by me in the
"Follow -up Pilot Survey ", so that the general prognosis
was already known.
The old policy of watchful waiting has become
untenable and in the ideal situation the surgical procedure
of choice is a primary one -stage resection of the affected
bowel with end -to -end anastomosis. However, such a method
can not supplant good medical treatment in the majority of
uncomplicated cases, and should not be substituted for
multiple staged operative procedures in the presence of
certain complications.
