Treatment of perforated diverticular disease involves:
parenteral antibiotics
laparotomy with a generous midline incision to gain access to sites as distant as the splenic flexure and the pelvis
peritoneal toilet
diversion of the faecal stream and removal of diseased bowel is indicated if faecal peritonitis or squeezing the bowel causes gas or other matter to emerge from the inflamed region. Choices include:
primary resection of the perforated region with direct anastomosis
hemicolectomy with or without a defunctioning transverse colostomy for the proximal end
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