Surgical management of colonic diverticulitis and complicated diverticulosis.

The aim of surgery in the management of diverticulitis and complicated diverticulosis is to remove the disease process as quickly as possible. This approach reduces the likelihood of complications and often avoids the necessity of multistage procedures. Indications for resection include failure of a first attack to subside, recurrent attacks, and free perforation with spreading peritonitis. Three-stage procedures should be reserved for extremely serious disease. Other complications requiring surgery are fistula, obstruction, and massive and uncontrolled bleeding. Massive bleeding is caused by diffuse colonic diverticulosis and is rarely associated with diverticulitis. Abdominal mass, obstruction, or recurrent episodes of slight bleeding should suggest the possibility of underlying tumor and are compelling indications for early resection.