Diagnosis and management of acute diverticulitis.

Although the diagnosis of acute diverticulitis is somewhat standardized, the scientific evidence and basis for treatment has been questioned. For years, medical and surgical management of acute diverticulitis has been based on the theory that more than 2 significant attacks of diverticulitis would lead to the recommendations of surgical resection. This should be questioned and further investigated with prospective randomized trials. Only a small number of well-published articles support the surgical management with good scientific data. Although our ability to take a history and skill of physical examination has not changed, the use of improved technology such as high-speed computerized axial tomography has afforded us the ability to make earlier and more accurate diagnoses. This may further allow us to standardize treatment and study outcomes. The time has come to further investigate and justify this management. It is possible that only the most critical situations may necessitate an operation. Clearly, the age group less than 40 years, as well as the immunocompromised, steroid-dependent, diabetic, and transplant patients, seem to be at greater risk with increased morbidity if not treated early and aggressively. And those individuals who present with perforation or compromised obstruction most likely will continue to need emergent intervention. We should try to set the rules by evidence-based medicine, while remaining within the confines of excellent and cost-effective care.