Surgical management of Acute complicated colonic diverticulitis

Edvardas Jukna1, Dovydas Melamed2, Kamilė Grigaitė3

1Joniškis Hospital

2Vilnius City Clinical Hospital

3Lithuanian University of Health Sciences, Academy of Medicine, Kaunas, Lithuania


Diverticula are a sac-like pouches of mucosa and submucosa that protrude through the muscular layer of the intestine. An inflammation due to microperforation is called diverticulitis. Colonic diverticula are most commonly found in the sigmoid colon (approximately 90%). Diverticulitis may occur in 10 to 25% of patients with diverticulosis. Diverticulitis can be divided into complicated diverticulitis, characterized by abscess, perforation, stricture, intestinal obstruction, or fistula, and uncomplicated diverticulitis, which does not have those symptoms. A modified Hinchey classification is based on computed tomography (CT) examination. CT scan with intravenous contrast is the gold standard for diagnosing the acute colonic diverticulitis, its complications and rejecting other pathologies. Imagining findings sensitivity and specificity for the diagnosis are 98% and 99%, respectively. If the size of abscess is limited, antibiotic therapy is safe and effective in treating stage I b diverticulitis. If the pool is larger than 4 cm, additional percutaneous drainage is required. Hinchey III and IV diverticulitis requires urgent surgical treatment. Traditionally, the gold standard for the treatment of those patients is the Hartmann‘s procedure (HP). Primary anastomosis with or without fecal diversion can be performed in selected patients with Hinchey III perforated diverticulitis. Laparoscopic lavage remains controversial to treat diverticulitis.

Aim: to review the recent literature on the treatment of acute complicated colon diverticulitis.

Methods: literature sources were selected from PubMed and Cohrane Library scientific databases. Certain keywords were used for the search of the most relevant and recent articles.

Conclusions: I B Hinchey stage diverticulitis can be treated conservatively. Percutaneous or laparoscopic drainage should be considered, if treatment is ineffective. For generalized stercoral peritonitis or an unstable patient, life-saving Hartmann‘s procedure is the first choice, and Hinchey stage III diverticulitis can be treated with a primary anastomosis, but it should be individually assessed by the patient‘s condition, age, comorbidities, and surgeon experience.

Keywords: acute colonic diverticulitis, complicated, Hinchey, Hartmann‘s procedure.