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Emergency Surgery for Acute Complicated Diverticulitis.

Ferdinand Köckerling1

  • 1Department of Surgery, Vivantes Hospital, Berlin, Germany.

Viszeralmedizin
|March 19, 2016
PubMed
Summary

Optimal treatment for acute complicated diverticulitis has evolved. Current approaches focus on interventional and minimally invasive methods to manage emergencies, followed by elective sigmoid resection to prevent high recurrence rates.

Keywords:
Complicated diverticulitisDiverticulitisHartmann's procedureHinchey stagesLaparoscopic lavage

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Area of Science:

  • Gastroenterology
  • Surgical Innovation
  • Medical Treatment Guidelines

Background:

  • The optimal management of acute complicated diverticulitis remains debated.
  • Treatment strategies have significantly evolved.
  • Current surgical focus is on emergency control via interventional and minimally invasive techniques.

Purpose of the Study:

  • To present current data and recommendations for differentiated treatment of acute complicated sigmoid diverticulitis.
  • To summarize treatment strategies in a decision tree format.

Main Methods:

  • Review of current data and recommendations.
  • Development of a decision tree for treatment guidance.
  • Application of interventional and laparoscopic procedures for acute management.

Main Results:

  • Sigmoid resection is generally required due to a 40% recurrence rate without it.
  • Interventional and laparoscopic approaches (drainage, lavage) manage abscesses and peritonitis (Hinchey stages I-IV).
  • Interval elective sigmoid resection is preferred after acute situation control; emergency resection is performed with primary anastomosis/stoma or Hartmann's procedure if unavoidable.

Conclusions:

  • Advances in interventional and laparoscopic treatments enable differentiated management strategies.
  • Modern concepts allow for tailored treatment of acute complicated sigmoid diverticulitis.