Treatment of Left-Sided Colonic Diverticulitis
Patient Guideline Summary
Publication Date: June 1, 2020
Last Updated: March 3, 2023
Objective
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
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
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
Treatment
Elective Surgery for Acute Diverticulitis
Emergency Surgery for Acute Diverticulitis
Laparoscopic Lavage
Technical Considerations
- 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.