Stage-Dependent Surgery of Colonic Diverticulitis

Abstract

Nearly 75% of persons hospitalized for acute colonic diverticulitis will respond to non-operative treatment that includes suitable antimicrobial therapy, and can be discharged home without undergoing surgery for their acute disease presentation (Ambrosetti et al. 1992). Operative Intervention is warranted in the remaining patients because of signs of generalized peritoneal irritation or diverticular disease complications, such as abscess, free Perforation, fistulization, or obstruction, that confound management and persist despite appropriate medical therapy. More specifically, clinical Peritonitis is found in 25% of patients undergoing emergent laparotomy for acute diverticulitis (Wedell et al. 1997). And, while abscesses are demonstrated by computerized tomography (CT) in only 16% of individuals admitted with left-sided colonic diverticulitis (Ambrosetti et al. 1992), 31-56% of persons undergoing emergent laparotomy will harbor an abscess (Killingback 1983; Rodkey u. Welch 1984; Ambrosetti et al. 1992). The operative management of these patients with diverticulitis complicated by Peritonitis or abscess has been retrospectively evaluated by many centers. To best analyze the resultant studies, one must consider the stage of Peritonitis, perioperative variables, operative alternatives, and outcome associated with each of the procedures. Unfortunately, the paucity of prospective trials makes it difficult to propose evidence-based recommendations.