ABSTRACT
The most common indications for emergency operative intervention in the treatment
of sigmoid diverticulitis are peritonitis and failure of medical therapy. Primary
resection and diversion (Hartmann's procedure) followed by delayed colostomy closure
is the current standard of emergency surgical care. Guidelines for best operative
strategy, however, remain controversial and continue to evolve based on recent comparative
reviews of surgical outcomes. Primary resection and anastomosis with or without proximal
diversion and laparoscopic lavage are alternatives to Hartmann's procedure that may
provide an improved outcome in properly selected patients. Ongoing changes in the
historical paradigm of the surgical approach to this disease mandate the need for
large multicentered prospective randomized trials to determine the best surgical strategy
under emergent conditions for the treatment of diverticulitis. The current literature
is reviewed with suggestions for a management algorithm.
KEYWORDS
Diverticular peritonitis - diverticulitis - peritonitis - Hartmann's procedure - primary
resection - anastomosis - laparoscopic lavage
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Valerie P BauerM.D.
Division of Colon and Rectal Surgery, Department of Surgery, University of Texas Medical
Branch
301 University Blvd., Rte. 0737, Galveston, TX 77555
Email: vabauer@utmb.edu
