Surgical treatment of colonic diverticulosis and diverticulitis

1. Big picture

Diverticulosis is the presence of colonic diverticula, usually in the sigmoid colon. It is often asymptomatic and does not need surgery. Diverticulitis is inflammation/infection of a diverticulum and becomes a surgical topic when it causes abscess, perforation, generalized peritonitis, fistula, stricture/obstruction, recurrent complicated disease, or severe bleeding.

For the oral exam, the examiner mainly wants you to answer:

“Which patient can be treated conservatively, which patient needs drainage, and which patient needs urgent resection?”

Acute left-sided diverticulitis is common in Western surgical practice; the sigmoid colon is most often involved. CT has become the key diagnostic and staging tool, and surgical choice depends on CT stage plus physiology: stable patient → conservative/drainage or primary anastomosis; unstable septic patient → Hartmann or damage-control surgery. ([SpringerLink][1])

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