Clin Colon Rectal Surg 2004; 17(3): 177-182
DOI: 10.1055/s-2004-832699
Copyright © 2004 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA.

Emergency Management of Diverticulitis

Nancy N. Baxter1
  • 1Department of Surgery, University of Minnesota, Minneapolis, Minnesota
Further Information

Publication History

Publication Date:
25 August 2004 (online)

Diverticulitis is a common problem, and although most cases will respond to conservative measures, surgeons will frequently need to treat patients requiring emergency surgery. Surgical management has progressed over the past 30 years, with a change in practice from routine drainage and proximal diversion (necessitating two further major procedures) to primary resection and anastomosis in selected cases. In 2004, surgeons must use clinical judgment to determine which approach will optimize outcomes both in terms of morbidity and mortality and in terms of quality of life for their patients.

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Nancy N BaxterM.D. 

Division of Colon and Rectal Surgery Oncology, Department of Surgery, University of Minnesota

MMC 450, 420 Delaware St. SE

Minneapolis, MN 55455

Email: baxte025@umn.edu

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