REVIEW   

Minerva Chirurgica 2020 June;75(3):173-92

DOI: 10.23736/S0026-4733.20.08314-5

Copyright © 2020 EDIZIONI MINERVA MEDICA

language: English

Acute diverticulitis: old challenge, current trends, open questions

Renato COSTI ^{1, 2, 3}, Alfredo ANNICCHIARICO ¹ ✉, Andrea MORINI ¹, Andrea ROMBOLI ¹, Alban ZARZAVADJIAN LE BIAN ^{4, 5}, Vincenzo VIOLI ^{1, 2, 3}

¹ Department of Medicine and Surgery, University of Parma, Parma, Italy; ² Unit of General Surgery, Department of Surgery, Hospital of Vaio, Fidenza, Parma, Italy; ³ AUSL di Parma, Parma, Italy; ⁴ Service of General, Digestive, Oncologic, Bariatric, and Metabolic Surgery, Avicenne Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France; ⁵ Paris XIII University, Bobigny, France

Acute diverticulitis (AD) is an increasing issue for health systems worldwide. As accuracy of clinical symptoms and laboratory examinations is poor, a pivotal role in preoperative diagnosis and severity assessment is played by CT scan. Several new classifications trying to adapt the intraoperative Hinchey’s classification to preoperative CT findings have been proposed, but none really entered clinical practice. Treatment of early AD is mostly conservative (antibiotics) and may be administered in outpatients in selected cases. Larger abscesses (exceeding 3 to 5 cm) need percutaneous drainage, while management of stages 3 (purulent peritonitis) and 4 (fecal peritonitis) is difficult to standardize, as various approaches are nowadays suggested. Three situations are identified: situation A, stage 3 in stable/healthy patients, where various options are available, including conservative management, lavage/drainage and primary resection/anastomosis w/without protective stoma; situation B, stage 3 in unstable and/or unhealthy patients, and stage 4 in stable/healthy patients, where stoma-protected primary resection/anastomosis or Hartmann procedure should be performed; situation C, stage 4 in unstable and/or unhealthy patients, where Hartmann procedure or damage control surgery (resection without any anastomosis/stoma) are suggested. Late, elective sigmoid resection is less and less performed, as a new trend towards a patient-tailored management is spreading.

KEY WORDS: Diverticulitis; Diagnosis; Operative surgical procedures