[Surgical treatment of acute sigmoiditis]

Virtually unknown at the beginning of the century, diverticulosis has become very prevalent in western countries. The natural history of the disease is notable for its acute, sometimes recurrent, attacks of diverticulitis and the significant risk of serious complications : abscess, fistula, peritonitis. CT scanning predominates in the diagnostic evaluation. It can provide both diagnostic and prognostic information. Most mild attacks of diverticulitis respond well to medical therapy while surgical treatment is indicated in the complicated forms of the disease. Surgical therapy has gradually evolved from a complicated three stage approach to two-staged, single-staged, or even minimally invasive procedures. The current trend is to intervene surgically well after the resolution of the acute attack. To achieve this, liberal use of percutaneous drainage of collections and medical treatment are advocated. The decision to perform prophylactic sigmoid resection must be based on a balance assessment of risk factors including age, severity of attacks and their recurrence.