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World J Gastroenterol. Feb 21, 2010; 16(7): 804-817
Published online Feb 21, 2010. doi: 10.3748/wjg.v16.i7.804
Current indications and role of surgery in the management of sigmoid diverticulitis
Luca Stocchi
Luca Stocchi, Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH 44195, United States
Author contributions: Stocchi L performed the research on current literature, analyzed the data and wrote the paper.
Correspondence to: Luca Stocchi, MD, Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, 9500 Euclid Avenue, Desk A30, Cleveland, OH 44195, United States. stocchl@ccf.org
Telephone: +1-216-4456378  Fax: +1-216-4458627
Received: November 14, 2009
Revised: December 9, 2009
Accepted: December 16, 2009
Published online: February 21, 2010
Abstract

Sigmoid diverticulitis is a common disease which carries both a significant morbidity and a societal economic burden. This review article analyzes the current data regarding management of sigmoid diverticulitis in its variable clinical presentations. Wide-spectrum antibiotics are the standard of care for uncomplicated diverticulitis. Recently published data indicate that sigmoid diverticulitis does not mandate surgical management after the second episode of uncomplicated disease as previously recommended. Rather, a more individualized approach, taking into account frequency, severity of the attacks and their impact on quality of life, should guide the indication for surgery. On the other hand, complicated diverticular disease still requires surgical treatment in patients with acceptable comorbidity risk and remains a life-threatening condition in the case of free peritoneal perforation. Laparoscopic surgery is increasingly accepted as the surgical approach of choice for most presentations of the disease and has also been proposed in the treatment of generalized peritonitis. There is not sufficient evidence supporting any changes in the approach to management in younger patients. Conversely, the available evidence suggests that surgery should be indicated after one attack of uncomplicated disease in immunocompromised individuals. Uncommon clinical presentations of sigmoid diverticulitis and their possible association with inflammatory bowel disease are also discussed.

Keywords: Sigmoid diverticulitis; Diverticulitis management; Diverticulitis surgery; Acute diverticulitis; Complicated diverticulitis; Perforated diverticulitis; Laparoscopic colectomy