Diverticular disease of the colon occurs quite frequently in developed countries, and its prevalence has recently increased in Japan. The appearance of
diverticulosis increases with age, although mostly remaining asymptomatic. Approximately 20% of cases require treatment. As the Western lifestyle and number of elderly people increase, the need for medical treatment also increases. Computed tomography (CT) is the gold standard for diagnosing
diverticulitis. Complicated
diverticulitis is classified by the size and range of
abscess formation and the severity of the
peritonitis. Each case should be classified based on clinical and computed tomography (CT) findings and then treated appropriately. Most patients with uncomplicated
diverticulitis (stages 0-Ia) can be treated conservatively.
Diverticulitis with a localized
abscess (stages Ib-II) is generally resolved with
conservative treatment. If the
abscess is larger or
conservative treatment fails, however, percutaneous drainage or surgery should be considered. Operative treatment is considered standard
therapy for severe
diverticulitis with perforation and generalized
peritonitis (stages III-IV).
Colonic diverticulitis treated conservatively frequently recurs. Elective surgery after recovery should be considered carefully and decisions made on a case-by-case basis. Because cases of
colonic diverticulitis will undoubtedly increase in Japan, it is likely that we will be confronted with increasing numbers of treatment decisions. We therefore need to have a systematic strategy for treating the various stages of
colonic diverticulitis appropriately. We herein review the management of complicated
diverticulitis.