Management of Complicated Diverticulitis

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After recovery from a new onset of diverticulitis, the patient should undergo a colonoscopy or, alternatively, a barium enema to rule out an alternative diagnosis, most importantly, carcinoma. These studies should be obtained after acute inflammation has resolved. There is no clear guideline for who should undergo an elective prophylactic colectomy. The following is a recommended list:

• Based on decision analysis models, the preferred timing of elective surgery to optimize life expectancy is after the third or fourth episode of uncomplicated diverticulitis.
• Transplant patients or patients with chronic diseases affecting their immunity, including chronic use of steroids, should be offered a colectomy after a documented case of diverticulitis.
•  Patients with an episode of complicated diverticulitis with persistent or recurrent symptoms or immunocompromised or young.
• Patients with complicated diverticulitis who have an anatomic deformity, including a stricture or fistula.

The timing of this elective colectomy is debated on but, generally, one waits 4 to 6 weeks to allow the inflammation to subside. Laparoscopy is preferred over open colectomy in the setting of acute uncomplicated diverticulitis. There are no data concerning laparoscopic versus open surgery for complicated diverticulitis.