Treatment of Left-Sided Colonic Diverticulitis

Patient Guideline Summary

Publication Date: June 1, 2020

Last Updated: March 3, 2023

Objective

This patient summary means to discuss key recommendations from the American Society of Colon and Rectal Surgeons (ASCRS) for the treatment of left-sided colonic diverticulitis. It is limited to adults 18 years of age and older and should not be used as a reference for children.

Overview

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.

Diagnosis

Evaluation After Recovery from Acute Diverticulitis

After the resolution of an episode of acute complicated diverticulitis, the diagnosis should be confirmed by colonoscopy (examining the colon with a flexible scope).

Treatment

Elective Surgery for Acute Diverticulitis

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

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.

Technical Considerations

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.

Abbreviations

ASCRS: American Society Of Colon And Rectal Surgeons

Disclaimer

The information in this patient summary should not be used as a substitute for professional medical care or advice. Contact a health care provider if you have questions about your health.