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Drains, Germs, or Steel: Multidisciplinary Management of Acute Colonic Diverticulitis

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Abstract

The medical and surgical management of uncomplicated diverticulitis has changed over the last several years. Although immunocompetent patients or those without comorbidities can be treated with antibiotics as an outpatient, the efficacy of high-fiber intake or drugs such as mesalamine or rifaximin is not yet clearly established in the treatment of acute episodes and in the prevention of recurrences. On the other hand, the choice between antibiotic treatment and percutaneous drainage is not always obvious in diverticulitis complicated by abscess formation, especially for larger abscesses; although the results of studies comparing the two approaches remain controversial, surgery must be pursued for abscesses > 8 cm. For emergency surgery, the debate is still ongoing regarding laparoscopic lavage and surgical resection followed by primary anastomosis, since for both approaches the published reports are not in agreement regarding possible benefits. Therefore, these approaches are recommended only for selected patients under the care of experienced surgeons. Also, the contribution of elective surgery toward the overall approach has been revised; currently, it is reserved primarily for patients with a high risk of recurrence and whenever more conservative treatments were not effective.

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Abbreviations

5-ASA:

5-Aminosalicylic acid

AD:

Acute diverticulitis

CRP:

C reactive protein

CT:

Computed tomography

DD:

Diverticular disease

HP:

Hartmann’s procedure

IBS:

Inflammatory bowel disease

LL:

Laparoscopic lavage

NSAIDs:

Non-steroidal anti-inflammatory drugs

PCD:

Percutaneous drainage

RCTs:

Randomized control trials

SUDD:

Symptomatic uncomplicated diverticular disease

WSES:

World Society of Emergency Surgery

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Acknowledgments

We wish to thank Ms. Claudia CIRILLO for her English language editing of our text.

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Authors and Affiliations

  1. Emergency Surgery Department, St. Orsola University Hospital, Bologna, Italy

    Augusto Lauro, Eleonora Pozzi, Maurizio Cervellera & Valeria Tonini

  2. Department of Surgical Sciences, Umberto I University Hospital - La Sapienza, Rome, Italy

    Samuele Vaccari

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Lauro, A., Pozzi, E., Vaccari, S. et al. Drains, Germs, or Steel: Multidisciplinary Management of Acute Colonic Diverticulitis. Dig Dis Sci 65, 3463–3476 (2020). https://doi.org/10.1007/s10620-020-06621-8

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