Acute Colonic Diverticulitis

Abstract

Acute colonic diverticulitis encompasses a variety of conditions, ranging from localized inflammation of the diverticula without colon wall perforation to severe diffuse fecal peritonitis caused by diverticula perforation and inflammation affecting the extensive colon segment. The clinical presentation of acute diverticulitis depends on the severity and localization of the underlying inflammatory process. The accurate clinical diagnosis of acute diverticulitis is difficult to make; therefore, routine imaging such as computed tomography and ultrasound has been recommended for patients with a clinical suspicion of acute diverticulitis. Computed tomography is required to establish the diagnosis; however, it may guide clinicians in the management of acute diverticulitis. Patients with acute uncomplicated diverticulitis may be treated in outpatient or inpatient setting, and conservative treatment including antibiotics is successful in most cases. Although some patients with acute complicated diverticulitis can be treated medically or by percutaneous drainage, patients with diffuse peritonitis due to acute diverticulitis require surgery. The choice of surgical techniques depends upon the patient’s hemodynamic stability, extent of inflammation and peritoneal contamination, and surgeon experience. Traditionally, surgery for acute complicated diverticulitis encompasses one-stage procedures and two-stage procedures; colon resection can be performed open or laparoscopically. However, acute diverticulitis with diffuse peritonitis is a life-threatening condition, and correct surgical management with early source control is essential.