Emergent and elective surgery for diverticulitis.

The scientific evidence and basis for standardized treatment for diverticulitis has been questioned. For years, medical and surgical management of acute diverticulitis included 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. It is possible that only the most critical situations may necessitate an operation. The age group less than 40 years, the immunocompromised, steroid-dependent, diabetic, and transplant patients, seem to be at greater risk with increased morbidity if not treated early and aggressively. Those individuals who present with perforation or compromised obstruction most likely will continue to need emergent intervention. But we need to reevaluate who needs surgical intervention while remaining within the confines of excellent and cost-effective care.