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Updated Guidelines Issued for Management of Diverticulitis

FRIDAY, May 22, 2020 -- In clinical practice guidelines from the American Society of Colon and Rectal Surgeons, published in the June issue of Diseases of the Colon & Rectum, updated recommendations are presented for the management of diverticulitis.

Jason Hall, M.D., M.P.H., from Boston University School of Medicine, and colleagues updated guidelines for the clinical management of diverticulitis, focusing on left-sided disease, in line with evolving understanding of diverticulitis.

According to the authors, the initial evaluation of a patient should include a history, physical examination, and appropriate laboratory evaluation. The most appropriate initial imaging modality is computed tomography scan of the abdomen and pelvis. Treatment without antibiotics is appropriate for selected patients with uncomplicated diverticulitis; antibiotics may be included in nonoperative management. For stable patients with abscesses >3 cm in size, image-guided percutaneous drainage is usually recommended. Lifestyle interventions can potentially reduce the risk for diverticulitis. The colon should typically be endoscopically evaluated to confirm diagnosis after resolution of acute complicated diverticulitis. Elective resection should typically be considered after successful nonoperative treatment of a diverticular abscess. For patients with diverticulitis complicated by fistula, obstruction, or stricture, elective colectomy is recommended. Elective resection is not recommended based on young age at presentation. The decision to recommend elective sigmoid colectomy after recovery from acute diverticulosis should be individualized. For patients with diffuse peritonitis or those in whom nonoperative management fails, urgent sigmoid colectomy is typically advised.

"The ultimate judgment regarding the propriety of any specific procedure must be made by the physician in light of all the circumstances presented by the individual patient," the authors write.

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