Pathogenesis and Management of Acute Colonic Diverticulitis

Summary

The management of patients with acute diverticulitis is evolving. There is increasing evidence from observational studies that lifestyle factors such as BMI and physical activity influence the risk of development of acute diverticulitis, but whether modification can reduce this risk requires evaluation by controlled trials. The traditional management of bowel rest, intravenous fluids and antibiotics is being challenged for low-risk patients, although there is currently a lack of high-quality data to support this as a routine approach. The surgical management of patients failing medical treatment for acute diverticulitis has moved away from open surgical intervention to a minimally invasive approach in selected patients with laparoscopic wash out showing promising results and preventing the need for stoma formation. An area of ongoing interest is the potential prevention of recurrent episodes of acute diverticulitis by anti-inflammatory drugs or treatments modifying the gut microbota. However, we currently lack a clear understanding of the mechanism underlying recurrence and therefore planning appropriate adequately powered trials is challenging.