Clin Colon Rectal Surg 2009; 22(3): 161-168
DOI: 10.1055/s-0029-1236160
Published by Thieme Medical Publishers

Emergency Management of Diverticulitis

Valerie P. Bauer1
  • 1Division of Colon and Rectal Surgery, Department of Surgery, University of Texas Medical Branch, Galveston, Texas
Further Information

Publication History

Publication Date:
10 August 2009 (online)

ABSTRACT

The most common indications for emergency operative intervention in the treatment of sigmoid diverticulitis are peritonitis and failure of medical therapy. Primary resection and diversion (Hartmann's procedure) followed by delayed colostomy closure is the current standard of emergency surgical care. Guidelines for best operative strategy, however, remain controversial and continue to evolve based on recent comparative reviews of surgical outcomes. Primary resection and anastomosis with or without proximal diversion and laparoscopic lavage are alternatives to Hartmann's procedure that may provide an improved outcome in properly selected patients. Ongoing changes in the historical paradigm of the surgical approach to this disease mandate the need for large multicentered prospective randomized trials to determine the best surgical strategy under emergent conditions for the treatment of diverticulitis. The current literature is reviewed with suggestions for a management algorithm.

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Valerie P BauerM.D. 

Division of Colon and Rectal Surgery, Department of Surgery, University of Texas Medical Branch

301 University Blvd., Rte. 0737, Galveston, TX 77555

Email: vabauer@utmb.edu

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