Controversies in the Diagnosis and Management of Diverticulitis Coli

Background: Diverticulitis is a common disease, especially in the developed world. The treatment has evolved substantially as our understanding of the pathophysiologic process has improved, and the tools available for diagnosis and treatment have advanced. Methods: Review and synthesis of the pertinent international literature. Results: A number of controversies exist with regard to therapy for diverticulitis. Recent evidence has highlighted the indications for elective surgical intervention, and stressed that the major indication is relief of symptoms, not reduction in morbidity. Laparoscopic surgery, in trained hands, is as effective and safe as open surgery. For surgical therapy of Hinchey Grade III and IV diverticulitis, primary resection and anastomosis may be safer for most patient populations, with lower morbidity, than resection with end-sigmoid colostomy and a Hartmann pouch. Laparoscopic lavage may be useful for temporizing selected patients; however, more work is needed to define more precisely the patient groups in which this approach is appropriate. Finally, short courses of antibiotics and oral antibiotic therapy are effective for appropriate patients with uncomplicated diverticulitis. Conclusions: Medical and surgical therapy of diverticulitis both offer several options that must be tailored to the circumstances of the individual patient.