ABSTRACT
Diverticulitis is when a diverticulum becomes inflamed, which occurs in only a minority of the patients with diverticular disease. Imaging is of similar importance in the classification of complicated diverticulitis. Peritonitis can result in a variety of presentations from local abdominal tenderness to an acute abdomen with general abdominal pain and rigidity. Peritoneal contamination as a result of purulent and faecal peritonitis requires surgical management. Independent of the classification of complicated acute diverticulitis, the guiding therapeutic strategy must be based on clinical factors especially haemodynamic stability, local or diffuse peritonitis, risk factors such as a history of radiation, steroid administration, BMI and medical co-morbidity. Laparoscopic peritoneal lavage has emerged as a promising alternative to sigmoidectomy in patients with purulent peritonitis from perforated diverticulitis. Patients with diffuse fluid or air at distance need a diagnostic laparoscopy to differentiate between purulent and faecal peritonitis. Patients with faecal peritonitis need to be resected, preferably laparoscopically.
