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Clin Colon Rectal Surg 2004; 17(3): 169-176
DOI: 10.1055/s-2004-832698
Copyright © 2004 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA.

Nonoperative Management of Complicated Diverticular Disease

David M. Schaffzin1 , W. Douglas Wong1
  • 1Memorial Sloan Kettering Cancer Center, New York, New York
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Publication Date:
25 August 2004 (online)

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The complications of diverticular disease of the colon can be divided into those related to inflammatory conditions (diverticular abscess, fistula, and perforation) and those related to noninflammatory conditions (lower gastrointestinal hemorrhage and noninflammatory stricture or obstruction). Nonoperative management of uncomplicated diverticulitis includes bowel rest and antibiotics. For abscesses, percutaneous drainage by radiologic guidance often turns complicated diverticulitis to an uncomplicated condition. In very select instances, fistulas or even perforation may be managed without operation. Strictures may be dilated or stented. Diverticular hemorrhage may be controlled with colonoscopic and angiographic techniques. For colonoscopy, these include cautery, epinephrine injection, and endoclips. For angiography, these include arterial infusion of vasopressin and selective embolization of bleeding vessels. For both diverticulitis and diverticular bleeding, these nonoperative therapeutic modalities may be utilized as a bridge to surgery, or in select instances as a definitive therapy obviating the need for surgery.

KEYWORDS

Diverticulitis - diverticular bleeding - nonoperative management

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W. Douglas WongM.D. 

Memorial Sloan Kettering Cancer Center

1275 York Ave., C1067, New York

NY 10021

Email: Wongd@MSKCC.org