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Minerva Chirurgica 2018 Jan 23

DOI: 10.23736/S0026-4733.18.07591-0

Copyright © 2018 EDIZIONI MINERVA MEDICA

lingua: Inglese

Acute diverticulitis and surgical treatment

José V. ROIG 1 , Luis SÁNCHEZ-GUILLÉN 2, Juan J. GARCíA-ARMENGOL 1

1 Coloproctology Unit, Hospital Vithas-Nisa, Valencia, Spain; 2 Coloproctology Unit, General and Digestive Surgery Department, Hospital Universitario de Elche, Elche, Spain


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Diverticulitis is a common condition in industrialized countries and an important cause of hospital admissions. Its growing trend is a challenge for the surgeons who perform emergency surgery, because approximately 15-25 percent of the patients will require surgery, being the surgical management of complicated acute diverticulitis controversial. The past decade has seen a paradigm shift in the treatment of sigmoid diverticulitis based on new epidemiological studies and refinement of surgical techniques that has produced a reassessment of our guidelines. CT imaging and sepsis scores allows to stratify the patients and better define the therapeutic strategies in each case. Special considerations must also be made for patients with a high surgical risk, such as immunosuppressed ones. The recommendations to perform surgery after two episodes of uncomplicated diverticulitis have been re-evaluated and the belief that new episodes may be complicated and associated with high morbidity and mortality has been rejected, since the clinical manifestations of this disease are usually defined by the first attack. In complicated cases, more patients can be treated with resection and primary anastomosis with or without an associated stoma, whose reversal rate is much higher than that of a Hartmann’s procedure. Likewise, laparoscopic surgery performing a peritoneal lavage and drainage without associated resection may have an increasing role in the management of these patients, although with controversial results, having become laparoscopic colon resection the approach of choice for the treatment of this pathology in elective settings.


KEY WORDS: Diverticular disease - Sigmoid diverticulitis - Complicated acute diverticulitis - Hartmann’s procedure - Primary colonic resection and anastomosis - Laparoscopic lavage

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Publication History

Article first published online: January 23, 2018
Manuscript accepted: January 5, 2018
Manuscript received: December 8, 2017

Per citare questo articolo

Roig JV, Sánchez-Guillén L, García-Armengol JJ. Acute diverticulitis and surgical treatment. Minerva Chir 2018 Jan 23. DOI: 10.23736/S0026-4733.18.07591-0

Corresponding author e-mail

roigvila@telefonica.net