[Case reports on 6 patients illustrating some of the surgical problems of diverticular disease and its complications]

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.