[Management of sigmoid diverticulitis]

While a majority of patients with diverticular disease remain asymptomatic, a subset will develop complications such as diverticulitis or bleeding. Simple diverticulitis is successfully managed with oral or intravenous antibiotics. Complicated diverticulitis is defined by the presence of abscess, fistula, stenosis or peritonitis. The severity of infectious complications is assessed by the Hinchey classification. Hinchey I stage is a small (<4 cm) pericolic abscess and is treated with intravenous antibiotics. Hinchey II stage is a larger (<4 cm) pelvic abscess, which usually requires percutaneous CT scan-guided drainage in addition to antibiotics. Hinchey III stage refers to purulent peritonitis and Hinchey IV to fecal peritonitis. Both stages require an emergent laparotomy. Indications for an elective sigmoidectomy are: a) two or more previous episodes of simple diverticulitis; and b) one episode of complicated diverticulitis.