Last updated January 11, 2022

Treatment of Sigmoid Diverticulitis

Recommendations

Medical Treatment of Acute Diverticulitis

Nonoperative treatment typically includes oral or intravenous antibiotics and diet modification. (1C)
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Image-guided percutaneous drainage is usually the most appropriate treatment for stable patients with large diverticular abscesses. (1B)
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Evaluation After Recovery From Acute Diverticulitis

After resolution of an episode of acute diverticulitis, the colon should typically be endoscopically evaluated to confirm the diagnosis, if this is a first episode or recent colonoscopy has not been performed. (1C)
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Elective Surgery for Acute Diverticulitis

The decision to recommend elective sigmoid colectomy after recovery from uncomplicated acute diverticulitis should be individualized. (1B)
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Elective colectomy should typically be considered after the patient recovers from an episode of complicated diverticulitis. (1B)
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Routine elective resection based on young age (<50 years) is no longer recommended. (1C)
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Emergency Surgery for Acute Diverticulitis

Urgent sigmoid colectomy is required for patients with diffuse peritonitis or for those in whom nonoperative management of acute diverticulitis fails. (1B)
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Following resection, the decision to restore bowel continuity must incorporate patient factors, intraoperative factors, and surgeon preference. (1C)
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In patients with purulent or feculent peritonitis, operative therapy without resection is generally not an appropriate alternative to colectomy. (1C)
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Technical Considerations

The extent of elective resection should include the entire sigmoid colon with margins of healthy colon and rectum. (1C)
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When expertise is available, the laparoscopic approach to elective colectomy for diverticulitis is preferred. (1A)
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A leak test of the colorectal anastomosis should be performed during surgery for sigmoid diverticulitis. (1C)
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Ureteral stents are used at the discretion of the surgeon. (2C)
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Oral mechanical bowel preparation is not required; however, the use of oral antibiotics may decrease surgical site infections after elective colon resection. (1B)
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Elective colectomy for diverticulitis may be performed by sparing the superior hemorrhoidal artery or according to cancer surgery principles. (1C)
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Recommendation Grading

Overview

Title

Treatment of Sigmoid Diverticulitis

Authoring Organization

Publication Month/Year

January 1, 2014

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Inclusion Criteria

Female, Male, Adolescent, Adult, Child, Infant, Older adult

Health Care Settings

Ambulatory, Emergency care, Hospital, Outpatient

Intended Users

Dietician nutritionist

Scope

Diagnosis, Management, Treatment

Diseases/Conditions (MeSH)

D004238 - Diverticulitis, D004240 - Diverticulum, D004241 - Diverticulum, Colon

Keywords

diverticulitis, diverticulosis, fistula