Management of complicated diverticulitis

The treatment of complicated diverticular disease is evolving and remains controversial. The operative choices are numerous and often based on intra-operative findings. Surgeons must consider the general health of the patient, the integrity of the bowel and the morbidity associated with reoperation when making up their minds about the appropriate operation to perform. To ease the surgeons' decision and optimize patient care, initial therapies should be directed towards converting the surgery from an emergent to an urgent or even elective procedure. Treating the patient with intravenous fluid and antibiotics, draining abscesses percutaneously, minimizing the anesthetic risks of co-morbidities with medical therapy and mechanic preparation of the bowel can achieve this. By following these general principles, many urgent "Hartmann" procedures can be converted to elective resections with primary anastomosis.