A 50-year-old woman presents with acute severe diverticulitis complicated by purulent peritonitis. She is hemodynamically stable after fluid resuscitation. What is the surgical procedure of choice?

• A Primary resection with anastomosis and proximal loop ileostomy
• B Laparoscopic peritoneal lavage and drainage
• C Hartmann's procedure (sigmoid resection with end colostomy) ✓
• D Diverting loop transverse colostomy

Explanation

Hartmann's procedure is the standard of care for purulent or feculent peritonitis secondary to diverticulitis. It involves resection of the diseased sigmoid colon, closure of the rectal stump, and formation of an end colostomy. Primary anastomosis is avoided in the setting of peritonitis due to high leak rates. Laparoscopic lavage has fallen out of favor due to poor outcomes in the SCANDIV and Ladies trials.

Reference: Bailey and Love's Short Practice of Surgery, 28th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.