Changing paradigms in the management of complicated diverticulitis

Complicated colonic diverticulitis remains a frequent cause of hospital admissions in Western countries, associated with significant morbidity and health care utilization. Complications include abscess formation, perforation, sepsis, fistulas, and colonic stenosis, which may be present at initial presentation or develop during the disease course. Approximately 10%-20% of hospitalized diverticulitis cases are classified as complicated. Over recent decades, the management of this condition has undergone a paradigm shift-from routine surgical intervention to more individualized, evidence-based strategies emphasizing conservative treatment where appropriate. This review provides a comprehensive, clinically oriented summary of current diagnostic approaches, including the role of cross-sectional imaging, as well as non-operative and operative treatment options. It also outlines recommendations for follow-up, including indications for colonoscopy, and discusses ongoing controversies and future directions in the management of complicated diverticulitis.