EC Microbiology

Introduction: Acute diverticulitis is a critical condition in medical encounters that leads to hospital admissions with subsequent health care cost. Surgical management is indicated in small proportion of patients when diverticulitis is refractory to medical therapy. Surgical candidate may presents with perforation, obstruction, fistula and/or bleeding. The choice of techniques depends on many factors as hemodynamic stability, peritoneal contamination, and surgeon experience and/or preference.

Aim of Work: In this review, we will discuss surgical managements of patients with acute diverticulitis, effectiveness of operations, and important consideration.

Methodology: : A comprehensive and systematic search was conducted acute diverticular disease, diverticulitis, diverticular complication and surgical management. PubMed search engine and Google Scholar search were the mainly used database for search process. All relevant available and accessible articles of all types were reviewed and included.

Conclusion: : : Most patients with freely perforated diverticulitis need surgery. However, the choice of surgical techniques depends mainly upon Hinchey staging system that assess the extent of peritoneal contamination. The primary goal of surgery is resection of the affected segment, however, the feasibility to achieve that depends greatly upon patient’s hemodynamic stability. The secondary goal of surgery is reconstruction and anastomosis to achieve intestinal continuity. Hartmann’s procedure is the most common two-stage feasible procedure in patients with excessive peritoneal involvement and critical presentation. Primary anastomosis with protective ostomy is another widely acknowledge surgical approach. The ASCRS recommend elective surgery for patient with history of complicated diverticulitis and in immunosuppressed patients regardless of disease status.

Keywords: Acute Diverticulitis; Fistula; Bleeding

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