Surgical Approach to Perforated Sigmoid Diverticulitis: A Case Report

Perforated sigmoid diverticulitis is a relatively uncommon but severe complication of diverticular disease, which itself is a leading cause of gastrointestinal morbidity. Although diverticulosis is prevalent, particularly in the aging population, perforation occurs in a smaller subset of cases and presents significant clinical challenges. This case report offers a thorough examination of the epidemiology, pathophysiology, clinical features, diagnostic techniques, and surgical management of perforated sigmoid diverticulitis. The condition most frequently affects middle-aged to older adults, with a bimodal age distribution that includes both the elderly and younger individuals with risk factors such as obesity, smoking, and low-fiber diets. The pathogenesis is characterized by increased intraluminal pressure within the diverticula, resulting in mucosal perforation, bacterial infiltration, and peritoneal inflammation. Symptoms typically include acute left lower quadrant pain, fever, and systemic signs of infection, although some patients may present with more subtle manifestations without overt signs of peritoneal irritation. Diagnostic assessment is largely reliant on advanced imaging techniques, with CT scanning considered the gold standard for confirming the diagnosis, revealing bowel wall thickening, fat stranding, and extraluminal gas. Additional laboratory tests, such as a complete blood count and inflammatory markers, are used to support the diagnosis and guide treatment. Surgical intervention is the primary treatment approach, with options ranging from resection with primary anastomosis, Hartmann’s procedure, or laparoscopic surgery, depending on the severity of the perforation and the patient's clinical status. The prognosis is closely linked to the timing of surgical intervention, and potential postoperative complications such as abscess formation, sepsis, and anastomotic leaks require vigilant management. This report aims to provide a deeper understanding of perforated sigmoid diverticulitis and emphasizes the importance of early diagnosis, appropriate treatment strategies, and improved patient outcomes based on the latest clinical evidence.