[Surgical therapy of acute diverticulitis]

Following conservative treatment of acute colonic diverticulitis at least one fourth of the patients experiences a further attack. The complication rate rises up to 60% at the recurrence. Therefore, colon resection is indicated at/following the second attack. For male patients below 50 years of age and with severe first attack, surgery is recommended already at/following the first attack. In the absence of diffuse fecal peritonitis, the one-stage colon resection with primary anastomosis is widely accepted, now. Percutaneous drainage of a peridiverticular or paracolic abscess is hazardous (success rate 70%), dangerous (consecutively delayed elimination of septic focus, 5% complication rate of drainage itself) and not necessary or helpful. Recurrent diverticulitis following sigmoid resection rarely occurs (1-11%) and is avoidable by removal of at least 20 cm colon including the rectosigmoid junction and anastomosis to the rectum. An extension of the resection towards cephalad direction to remove as much diverticula as possible seems not to decrease the risk of recurrent disease and is therefore not worthwhile.