Review Recommendations for Management of Acute Colonic Diverticulitis

Inaba K, Biffl WL, Costantini TW, et al. Evidence-Based, Cost-Effective Management of Acute Diverticulitis. An Algorithm of the Journal of Trauma and Acute Care Surgery Emergency General Surgery Algorithms Work Group. J Trauma Acute Care Surg. 2025; in press.

Acute colonic diverticulitis (ACD) is the cause of more than 200,000 hospital admissions per year in the US. The prevalence of this condition increases with age, especially in female patients. ACD of the left colon is the most common type diagnosed in North America. This article provided a clearly written set of recommendations for diagnosis and management of ACD.

Recommendations included using careful history and physical examination followed by CT imaging to confirm the diagnosis and assess disease severity. Use of available classification systems such as the Hinchey scale or the American Association for the Surgery of Trauma (AAST) grading system to estimate disease severity and guide initial treatment was recommended.

Evidence presented in the article confirmed that uncomplicated (Hinchey 0-1a or AAST grade 1) left-sided ACD can be successfully treated without antibiotics in carefully selected patients. Antibiotics can be used in patients with comorbid conditions, immunosuppression, and/or signs of systemic infection. Patients with localized peritonitis and fluid collections amenable to percutaneous drainage can be managed with this approach.

Operation (sigmoid resection with colostomy or with primary anastomosis and diverting ileostomy) is recommended for patients with more severe peritonitis/abscess. The authors emphasized that laparoscopic lavage was not recommended. A useful algorithm describing the steps of diagnosis and management is included in the article.

Surgeons are encouraged to review the entire article content.