Diverticular disease: update

Diverticular disease is an extremely common disease entity in our society. The major complication of diverticular disease, diverticulitis, can have quite variable presentations. In the acute setting, treatment is divided into nonsurgical (conservative) or surgical therapy. Cases of mild or "uncomplicated" disease benefit from a conservative approach involving antibiotic therapy. With more severe or "complicated" presentations (abscess, phlegmon, obstruction, fistula, or peritonitis), a more aggressive approach may involve percutaneous abscess drainage or urgent surgical therapy. This also may be required after a failed initial attempt at medical management. The decision regarding elective surgery after successful medical management of diverticulitis is more complicated. The primary goal is to minimize disease recurrence with as little morbidity as possible while maintaining a high quality of life. Recent evidence challenges indications for elective surgery. However, data on the natural history of recurrent diverticulitis are not clear enough to support altering current surgical guidelines. In addition, the increasing use of minimally invasive techniques with favorable outcomes for sigmoid colectomy must be considered. Prior to offering elective colectomy for diverticulitis, it remains important to individualize each case, giving special consideration to age, symptomatology, and recurrence. Ultimately, the decision for elective surgery is made by both the surgeon and a well-informed patient.