Resection of diverticular disease

Two-stage procedures are used in emergency situations where there has been peritoneal contamination. Common among the approaches is that the offending segment of diverticular disease is resected at the first operation.
(A) Stage 1 consists of the Hartmann's procedure; the diseased sigmoid colon is removed, the fecal stream is diverted, and the rectum is oversewn. In stage 2, intestinal continuity is reestablished by a descending colorectostomy.
(B) In stage 1, the diseased sigmoid is removed, and both ends of bowel are brought to the surface, one as an end colostomy and the other as a mucus fistula. In stage two, intestinal continuity is reestablished as in panel A.