The Treatment's Trend of Complicated Diverticulitis

Abstract

Mehmet Ince, Ozcan Altinel, Erol Aslan, Guven Yigit

Recurrent attacks are less likely to respond to medical treatment and have a high mortality rate; thus, most authorities agree that elective resection is indicated after two attacks of uncomplicated diverticulitis. Complicated diverticular disease refers to diverticulitis associated with bleeding, obstruction, free perforation, a fistula, or an abscess. A CT scan is an essential tool in the management of the complicated diverticulitis. Surgery is recommended for complicated diverticulitis after the first episode because of the risk of recurrent disease, and has changed over time from a three-stage approach to resection with primary anastomosis with or without protective loop ileostomy. Parameters for the treatment of complicated diverticulitis have changed because of advances in medical therapy, diagnostic modalities, and surgical techniques such as laparoscopic surgery in the two recent decades. The use of primary anastomosis has been recommended in all instances of complicated diverticulitis except purulent or fecal peritonitis. Therefore, our aim is to update our understanding of the treatment of patients with complicated diverticulitis in the current era.