Prognostic scoring systems-validation and their utility in patients with abdominal sepsis in colon peritonitis.

AIM: The purpose of this article is to analyze and validate the CR-POSSUM score in patients with peritonitis of colonic origin, considering mortality forecasting ability. METHODS: We conducted a prospective longitudinal study of the Surgery Clinic in the Emergency Hospital in Bucharest in January 2008-December 2011. Patients operated on for peritonitis of colonic origin were included in this study. The prognostic CR-POSSUM scores and Mannheim peritonitis index were calculated by using data from observation sheets. There have been a number of deaths and overall mortality was calculated. RESULTS: There were 58 patients with abdominal sepsis, hospitalized and operated, registering a 17.24% mortality rate. Time from admission until the time of operation was divided between up to 24 hours and over 24 hours, recording 27 (46.55%) cases operated <24 hours and 31 (53, 45%) of patients operated> for 24 hours. Operative severity scores were calculated by taking into account data provided by each surgeon on intraoperative appearance. CONCLUSIONS: The results of this study demonstrated that both CR-POSSUM score and Mannheim have a prognostic value for patients with abdominal sepsis in colonic peritonitis, both being surgery scores.

Complicated diverticular disease--our recent experience.

Diverticular disease is more frequently seen in our practice. The aim of this retrospective study was to evaluate our experience with complicated diverticular disease in our surgical emergency unit. Between 2004-2007 46 cases with complicated diverticular disease were registered in Surgical Emergency Clinical Hospital of Bucharest. A male preponderance (sex ratio M: F 1:1.4) and a medium age of 62.9 +/- 15 years were recorded. Perforation was the main complication encountered and sigmoid colon was the most frequent involved segment (71.7%). Diagnostic procedures relayed especially on CT-scan. Three cases were operated laparoscopically. Failure of conservative measures was the main cause for interventions. A Hartmann procedure was performed in 7 patients (15.2%). Global mortality was 8.1% (4 cases). There were no significant differences among the surgical procedures employed. Diverticular disease is more frequently encountered in our practice. CT-scan is the most efficient diagnostic tool but there are limitations. Conservative measures are not always successful and urgent operative treatment is the only choice. Hartmann procedure is still frequently employed in our practice.