Results from electronic determination of cell size-distribution pattern in cervical washings.

It is now generally accepted that proximal colostomy, temporary or permanent, is ineffective in the treatment of diverticular disease unless followed by resection. Pemberton et al. (1947) reported that 30% of the cases treated by a permanent colostomy were not controlled and that 70% of those whose colostomies were closed without resection had serious recurrent disease. Lloyd-Davies (1953) recorded similar experiences. These authors did not report control series treated by laparotomy only, but in the present series simple laparotomy gave a recurrence rate of 38% compared with 50% in patients treated by permanent colostomy and 50% in patients whose colostomies were closed without resection. Moreover, the most intractable cases were particularly prominent in the group undergoing colostomy without resection. These observations suggest the possibility that colostomy is not only ineffective but, by diverting the faecal stream and allowing contraction of the affected bowel, interferes with drainage of the diverticulum and favours inflammatory complications. That the prolonged use of proximal colostomy does indeed increase the severity of the disease process cannot be deduced with certainty from this series, as the numbers are too small, and the fallacies associated with retrospective studies must be taken into consideration. However, it is hoped that other workers may be stimulated to investigate this aspect of the management of diverticulitis.