Management of sigmoid diverticulitis from a surgical view

The management of sigmoid diverticulitis has changed during the last years. There is no doubt that immediate surgery is needed in case of perforation into the abdominal cavity as well as purulent and feculent peritonitis. Furthermore elective surgery is recommended in 'complicated' diverticulitis with an abscess, stenosis or fistula, and in chronic recurrent diverticulitis with persistent symptoms caused by the inflammation. In contrast to the opinion of most of German surgeons, the international literature proposes a conservative approach with a 'wait and see' strategy in case of 'uncomplicated' acute diverticulitis with perisigmoidal inflammation diagnosed by CT scan. These patients should be individually treated in consideration of age, co-morbidities, inflammation-related symptoms, and number and severity of the inflammation.