Acute diverticulitis: old challenge, current trends, open questions

Area of Science:

• Gastroenterology
• Surgical Oncology
• Radiology

Background:

• Acute diverticulitis (AD) presents a growing global health challenge.
• Clinical and laboratory diagnostics for AD lack accuracy, necessitating advanced imaging.
• Current CT-based classifications struggle to integrate with clinical practice.

Purpose of the Study:

• To review current diagnostic and management strategies for acute diverticulitis.
• To highlight the role of CT scans in preoperative assessment.
• To discuss evolving treatment paradigms for different stages of AD.

Main Methods:

• Review of existing literature on acute diverticulitis diagnosis and treatment.
• Analysis of CT scan's role in severity assessment.
• Discussion of standardized and emerging treatment algorithms for AD stages.

Main Results:

• CT scans are pivotal for accurate diagnosis and severity grading of AD.
• Early AD is often managed conservatively with antibiotics, including outpatient treatment.
• Management of complicated AD (stages 3 and 4) varies, with specific approaches for abscesses and peritonitis.
• Patient-tailored strategies are replacing routine elective sigmoid resection.

Conclusions:

• CT imaging is essential for guiding acute diverticulitis management.
• Treatment strategies for AD are increasingly individualized, considering patient stability and disease stage.
• The trend is moving away from routine elective surgery towards tailored, evidence-based interventions.