[Conservative and interventional therapy of acute diverticulitis with reference to pathophysiology]

Diverticular disease is most common in the sigmoid colon. Its etiology is multifactorial and probably related to low-fiber diets, age dependent changes of the colonic wall, hypermotility and myochosis with subsequent increase in intraluminal pressure. Acute diverticulitis results from inflammation of a pseudo-diverticulum. It can progress to pericolitis and perforation with abscess formation. Therapy of uncomplicated diverticulitis is a conservative regimen with bowel rest and intravenous broad spectrum antibiotics. In subjects with complicated diverticulitis, preoperative percutaneous image-guided catheter drainage of diverticular macroabscesses is indicated. This aims at resolving intra-abdominal sepsis thereby avoiding the need for temporary colostomy and multiple-stage surgery. Interval single stage sigmoid resection with primary anastomosis should then be performed. Generalized peritonitis, with or without evidence of free perforation, should be treated surgically. Long-term cereal fiber supplementation and physical activity may prevent complications and inflammatory recurrences in diverticular disease.