SURGICAL TREATMENT OF ACUTE INFLAMMATORY COMPLICATIONS OF SIGMOID DIVERTICULA

Abstract. Introduction. In recent years, a clear trend of increasing incidence of colonic diverticulosis has been observed worldwide, including in Ukraine, against the backdrop of an aging population. The likelihood of diverticulum formation increases with age, and in more than 65% of individuals over 65 years old, diverticula are found in the large intestine. This condition is characterized by the development of various acute inflammatory complications, ranging from localized inflammation (diverticulitis) to the formation of abscesses and fecal peritonitis due to perforation. These complications classify the condition as an urgent abdominal pathology, requiring timely diagnosis and an optimal surgical treatment strategy. The aim is to study the results of diagnosis and treatment of acute inflammatory complications of sigmoid colon diverticula. Materials and methods. An analysis was conducted on the treatment outcomes of 46 patients with inflammatory complications of sigmoid colon diverticula who were treated in the surgical department of KNP MCL No. 31 of the Kharkiv City Council from 2019 to 2024. The study included 31 (67.3%) women and 15 (32.3%) men, with ages ranging from 26 to 84 years (mean age: (61.6±6.6) years). According to the Hinchey classification (2005 modification): Stage I was observed in 20 (43.5%) patients, Stage II in 16 (34.8%) patients, Stage in 8 (17.4%) patients, and Stage IV in 2 (4.3%) patients. Results. Eleven patients with inflammatory complications of diverticula (Stage I) without perforation and/or with a paracolic abscess smaller than 3 cm underwent conservative treatment, which included antibiotic therapy (commonly cefazolin, fluoroquinolones, and metronidazole) along with symptomatic spasmolytic, anti-inflammatory, and infusion therapy. In cases of phlegmonous diverticulitis (9 patients, Stage I) with a pericolic abscess larger than 4 mm, percutaneous ultrasound-guided abscess drainage was performed. Primary resection of the sigmoid colon with anastomosis was performed in two patients with intramesenteric diverticular abscesses. In cases of diverticulitis perforation with fecal or widespread purulent peritonitis, the surgical procedure was minimized in duration and focused on infection source control. Conclusions. Ultrasound, along with CT, is a highly informative diagnostic method for evaluating patients with sigmoid colon diverticula, allowing visualization of inflammatory complications and proving valuable in emergency surgery settings. The combination of ultrasound, contrast-enhanced CT, and colonoscopy facilitates precise differential diagnosis of inflammatory complications of sigmoid colon diverticula and helps rule out alternative causes of inflammation and tissue destruction in the sigmoid colon.