Surgical treatment of sigmoid diverticulitis

The diagnosis and treatment of sigmoid diverticulitis presents several challenges to gastroenterologists and colorectal surgeons, challenges both logistical and technical. An algorithm is presented that may assist in the process of diagnosis and treatment. Young patients may be offered elective surgery after one proven severe attack of diverticulitis, but the timing of surgery in older patients with recurrent disease is more dependent on individual case-by-case decisions than a general rule. Important surgical principles are (1.) to resect all disease at the first operation; (2.) to avoid a primary anastomosis in the urgent situation unless all factors are favorable; (3.) to perform a minimal resection in the urgent case; (4.) to resect all distal disgmoid when operating definitively.