Abstract
Acute diverticulitis represents a common colorectal emergency seen in the Western
world. Over time, management of this condition has evolved. This review aims to highlight
recent evidence and update current recommendations. Notable evidence has emerged in
certain aspects of diverticulitis. This includes disease pathogenesis, as emerging
data suggest a potentially greater role for the microbiome and genetic predisposition
than previously thought. Acute management has also seen major shifts, where traditional
antibiotic treatment may no longer be necessary for acute uncomplicated diverticulitis.
Following successful medical management of acute diverticulitis, indications for elective
sigmoidectomy have decreased. The benefit of emergency surgery remains for peritonitis,
sepsis, obstruction, and acute diverticulitis in certain immunocompromised patients.
Routine colonoscopy, once recommended after all acute diverticulitis episodes, has
been shown to be beneficial for cancer exclusion in a distinct patient population.
Despite advances in research, certain entities remain poorly understood, such as smoldering
diverticulitis and symptomatic uncomplicated diverticular disease. As research in
the field expands, paradigm shifts will shape our understanding of diverticulitis,
influencing how clinicians approach management and educate patients.
Keywords
diverticulitis - diverticular disease - acute care surgery - colorectal surgery
