Treatment of Left-Sided Colonic Diverticulitis
Patient Guideline Summary
- Diverticulitis refers to an infection in diverticuli (pouches) protruding from the colon (large bowel). Diverticuli can occur anywhere in the colon.
- Younger patients are significantly more likely to require repeat hospitalization for diverticulitis.
- Symptoms include abdominal pain and tenderness, bloating, and disturbances in bowel habits.
- This patient summary focuses on surgical management of left-sided diverticulosis.
- After the resolution of an episode of acute complicated diverticulitis, the diagnosis should be confirmed by colonoscopy (examining the colon with a flexible scope).
- After successful nonoperative treatment of a diverticular abscess (pocket of infected pus), elective resection should typically be considered.
- Elective colectomy (removal of some of the large bowel) should typically be recommended for patients with diverticulitis complicated by fistula (abnormal opening), obstruction, or stricture.
Emergency Surgery for Acute Diverticulitis
- Urgent sigmoid colectomy is typically advised for patients with diffuse peritonitis (infection in the abdomen) or for those in whom non-operative management of acute diverticulitis fails.
- Following resection, the decision to restore bowel continuity should incorporate patient factors, intra-operative factors, and surgeon preference.
- Laparoscopic lavage (flushing the abdomen with saline) is not recommended in patients with feculent peritonitis (foul-smelling infection in the abdomen). Colectomy should typically be performed in this situation.
- The extent of elective resection should include the entire sigmoid colon with margins of healthy colon and rectum.
- When expertise is available, a minimally invasive approach to colectomy for diverticulitis is preferred.
- ASCRS: American Society Of Colon And Rectal Surgeons