Laparoscopic sigmoidectomy for perforated diverticulitis with purulent peritonitis – a video vignette

Acute diverticulitis with colonic perforation is common. Most surgeons would agree that surgery is indicated in the presence of peritonitis and sepsis. In this situation, most surgeons would avoid a primary anastomosis and consider open surgery to be necessary 1-5. This video (Video S1 in the online Supporting Information) illustrates a laparoscopic approach in a case of acute perforated diverticulitis of the sigmoid colon in which we performed a primary anastomosis. The operation commenced with an exploratory laparoscopy which revealed the presence of purulent peritonitis. We mobilized the splenic flexure to facilitate identification of the perforation. Colon mobilization was medium to lateral. The inferior mesenteric vein and artery were not dissected at their origin. We proceeded to the mesocolon section once the colon was mobilized. The sigmoid colon was divided using a linear stapler at the level of the sacral promontory. A primary anastomosis was performed and reinforced using interrupted sutures. We did not routinely perform a defunctioning ileostomy. This video suggests that a laparoscopic approach is feasible if appropriate facilities and expertise are available