Management of Acute Sigmoid Diverticulitis

Diagnostic Confirmation

The American Gastroenterological Association recommends CT scan with IV contrast as the preferred imaging modality to confirm diagnosis, assess severity, and stratify patients into uncomplicated versus complicated disease 3

The American Gastroenterological Association recommends selective rather than routine use of antibiotics in uncomplicated cases 1
When antibiotics are used, they should cover Gram-positive, Gram-negative, and anaerobic bacteria 2, 4

For hemodynamically unstable patients, damage control surgery with staged laparotomies is recommended rather than definitive resection 2, 6, 3
For hemodynamically stable patients, primary resection and anastomosis with or without diverting stoma is recommended 3
The empiric antibiotic regimen must be based on patient's clinical condition, presumed pathogens, and risk factors for antimicrobial resistance 2, 4, 7
Duration of antibiotic therapy should be 4 days postoperatively if adequate source control is achieved based on the STOP IT trial 2, 4, 5

The American Gastroenterological Association recommends waiting 6-8 weeks after resolution to exclude malignancy if high-quality colonoscopy not recently performed 1
Do not routinely recommend elective colonic resection after first episode of uncomplicated diverticulitis - recurrence risk is lower than historically thought (1.7-11.2% over 4-5 years) 1, 2

Immunocompromised patients warrant more aggressive initial management with lower threshold for hospitalization and antibiotics 2
Elderly patients should be managed with same principles but with heightened awareness of physiological reserve and comorbidities affecting surgical candidacy 8, 7