Ritz et al maanged patients with sigmoid diverticulitis based on the clinical severity. The authors are from Charite-Universitatsmedizin Berlin.
Patient selection: acute sigmoid diverticulitis, classified by Hansen and Stock stage
Disease Status
Management
free perforation and/or diffuse peritonitis
emergency surgery (sigmoidectomy, often with colostomy)
exacerbation of infection during antibiotic therapy
early elective sigmoid colectomy
other forms of complicated diverticulitis (Hansen and Stock IIa or IIb)
late elective sigmoid colectomy
first episode in an immunosuppressed patient
repeated attacks of diverticulitis (Hansen and Stock III)
all others
managed conservatively
Intravenous antibiotics were administered during episodes of acute diverticulitis. Intra-abdominal abscesses were drained when feasible.
Colonoscopy was performed after the acute inflammation had subsided if colonoscopy had not been performed in the previous 24 months.
Risk factors for free perforation:
(1) first or second episode of diverticulitis
(2) 2 or more significant comorbid conditions
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Specialty: Gastroenterology, Surgery, general
