title: Contemporary Review of Risk-Stratified Management in Acute Uncomplicated and Complicated Diverticulitis.
abstract: Acute colonic diverticulitis is a common clinical condition. Severity of the disease is based on clinical, laboratory, and radiological investigations and dictates the need for medical or surgical intervention. Recent clinical trials have improved the understanding of the natural history of the disease resulting in new approaches to and better evidence for the management of acute diverticulitis.
  
  
  
  We searched the Cochrane Library (years 2004-2015), MEDLINE (years 2004-2015), and EMBASE (years 2004-2015) databases. We used the search terms "diverticulitis, colonic" or "acute diverticulitis" or "divertic*" in combination with the terms "management," "antibiotics," "non-operative," or "surgery." Registers for clinical trials (such as the WHO registry and the https://clinicaltrials.gov/ ) were searched for ongoing, recruiting, or closed trials not yet published.
  
  
  
  Antibiotic treatment can be avoided in simple, non-complicated diverticulitis and outpatient management is safe. The management of complicated disease, ranging from a localized abscess to perforation with diffuse peritonitis, has changed towards either percutaneous or minimally invasive approaches in selected cases. The role of laparoscopic lavage without resection in perforated non-fecal diverticulitis is still debated; however, recent evidence from two randomised controlled trials has found a higher re-intervention in this group of patients.
  
  
  
  A shift in management has occurred towards conservative management in acute uncomplicated disease. Those with uncomplicated acute diverticulitis may be treated without antibiotics. For complicated diverticulitis with purulent peritonitis, the use of peritoneal lavage appears to be non-superior to resection.
authors.affiliation: Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Marja A
authors.initials: MA
authors.lastname: Boermeester
authors.affiliation: Division of Epidemiology and Public Health, School of Community Health Sciences, City Hospital, University of Nottingham, Clinical Sciences Building 2, Nottingham, UK. david.humes@nottingham.ac.uk.|Nottingham Digestive Diseases Biomedical Research Unit, Nottingham University Hospitals, University of Nottingham, Nottingham, NG7 2UH, UK. david.humes@nottingham.ac.uk.
authors.forename: David J
authors.initials: DJ
authors.lastname: Humes
authors.affiliation: Division of Trauma Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
authors.forename: George C
authors.initials: GC
authors.lastname: Velmahos
authors.affiliation: Department of Gastrointestinal Surgery, Stavanger University Hospital, P. O. Box 8100, 4068, Stavanger, Norway.|Department of Clinical Medicine, University of Bergen, Bergen, Norway.
authors.forename: Kjetil
authors.initials: K
authors.lastname: Søreide
mesh_terms: D000038:Abscess / Q000209:etiology / Q000601:surgery*; D000208:Acute Disease; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000072700:Conservative Treatment / Q000639:trends; D004238:Diverticulitis / Q000150:complications / Q000628:therapy*; D006801:Humans; D007416:Intestinal Perforation / Q000209:etiology / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods; D010533:Peritoneal Lavage; D010538:Peritonitis / Q000209:etiology / Q000628:therapy*; D018570:Risk Assessment
chemical_list: D000900:Anti-Bacterial Agents