ABSTRACT
This chapter focuses on the evaluation and treatment of complicated left-sided colonic diverticulosis and diverticulitis. Many of the microscopic features of diverticulitis include thickening of the lamina propria, mucin depletion and Paneth cell hyperplasia. Patients with acute diverticulitis typically present with left-sided abdominal pain, fever and leukocytosis with tenderness on examination. Rectal bleeding rarely occurs as a presentation of acute diverticulitis. Endoscopic evaluation of the colon is recommended following an acute episode of diverticulitis. Complicated diverticulitis is defined as diverticulitis associated with perforation, fistula, abscess, stricture or obstruction. Treatment of the complications of diverticulitis may range from treatment with bowel rest and parenteral antibiotics to emergent exploratory laparotomy. Traditionally, patients with diverticulitis and an associated abscess were treated by antibiotics and percutaneous drainage followed by interval elective sigmoid resection. Repeated attacks of diverticulitis may be associated with the development of a sigmoid stricture and progressive obstructive symptoms.
