Version July 2025
INTRODUCTION —
Diverticular disease of the colon is an important cause of hospital admissions and a significant contributor to health care costs in Western and industrialized societies [1,2]. In the United States, acute diverticulitis is the third most common gastrointestinal illness that requires hospitalization and the leading indication for elective colon resection [3,4].
The triage and inpatient management of patients with acute colonic diverticulitis is discussed in this topic. The discussion pertains mostly to the treatment of sigmoid diverticulitis; a brief discussion of diverticulitis of the right colon can be found at the end of the topic (see 'Right-sided (cecal) diverticulitis' below). Outpatient management and follow-up is the focus of another topic. (See "Acute colonic diverticulitis: Outpatient management and follow-up".)
The epidemiology, pathophysiology, clinical manifestations, diagnosis, complications, and surgical treatment of diverticulitis are discussed elsewhere:
●(See "Colonic diverticulosis and diverticular disease: Epidemiology, risk factors, and pathogenesis".)
●(See "Clinical manifestations and diagnosis of acute colonic diverticulitis in adults".)
●(See "Diverticular fistulas".)
●(See "Colonic diverticular bleeding".)
●(See "Acute colonic diverticulitis: Surgical management".)
UNCOMPLICATED VERSUS COMPLICATED DIVERTICULITIS —
Acute diverticulitis is suspected in patients with lower abdominal pain, abdominal tenderness with focal guarding (most typically in the left lower abdomen) on physical examination, and leukocytosis on laboratory testing. (See "Clinical manifestations and diagnosis of acute colonic diverticulitis in adults", section on 'Clinical manifestations'.)
The diagnosis is usually confirmed by an abdominopelvic computed tomography (CT) scan, which may also exclude alternative conditions (eg, perforated colon cancer, infectious or ischemic colitis) and distinguish complicated from uncomplicated disease by one of the following [5] (see "Clinical manifestations and diagnosis of acute colonic diverticulitis in adults", section on 'Acute complications'):
●Abscess
●Perforation
●Obstruction
●Fistulization
Acute uncomplicated diverticulitis can be treated nonoperatively in most patients (70 to 100 percent) [6-8], regardless of the treatment setting (out- versus inpatient) [9-13]. In systematic reviews of studies of uncomplicated diverticulitis, including a randomized trial (DIVER) [14], no differences in outcomes were found between outpatient and inpatient care [15,16]. However, acute complicated diverticulitis generally requires hospitalization and possibly interventional radiologic procedures and/or surgery. (See 'Treatment of complications' below.)
TRIAGE —
Based upon findings from the history, physical examination, laboratory studies, and CT scan, patients are triaged to either inpatient or outpatient treatment as discussed below and illustrated by the accompanying algorithm (algorithm 1).
Criteria for inpatient treatment — Patients with acute diverticulitis should receive inpatient treatment if [10,12,17] (table 1):
●CT shows complicated diverticulitis. (See 'Uncomplicated versus complicated diverticulitis' above.)
●CT shows uncomplicated diverticulitis, but the patient has one or more of the following characteristics [18]:
•Sepsis or systemic inflammatory response syndrome as defined by more than one of the following: Temperature >38 or <36°C, heart rate >90 beats per minute, respiration rate >20 respirations per minute, white blood cell count >12,000/mL or <4000/mL, C-reactive protein >15 mg/dL.
•Severe abdominal pain with failure to control abdominal pain in the emergency department to <5 on a visual analog scale.
•Age >70 years.
•Significant comorbidities (eg, diabetes mellitus with organic involvement [eg, retinopathy, angiopathy, nephropathy], a recent cardiogenic event [eg, acute myocardial infarction, angina, heart failure], or recent decompensation of chronic liver disease [≥Child B] or end-stage renal disease).
•Immunosuppression (eg, poorly controlled diabetes mellitus, chronic high-dose corticosteroid use, use of other immunosuppressive agents, advanced human immunodeficiency virus infection or acquired immunodeficiency syndrome, B or T cell leukocyte deficiency, active cancer of hematologic malignancy, or organ transplant).
•Intolerance of oral intake secondary to bowel obstruction or ileus.
•Noncompliance with care/unreliability for return visits/lack of support system.
•Failed outpatient treatment.
Criteria for outpatient treatment — Patients may be able to receive outpatient treatment for diverticulitis if they do not meet any of the criteria for inpatient treatment listed above. Outpatient management of diverticulitis is discussed in another topic. (See 'Criteria for inpatient treatment' above and "Acute colonic diverticulitis: Outpatient management and follow-up".)
INPATIENT TREATMENT —
Inpatient treatment of acute diverticulitis varies depending upon whether the patient has complicated or uncomplicated disease. All patients undergo treatment for diverticulitis with intravenous antibiotics, fluids, and pain medications. Patients with complicated diverticulitis must also undergo treatment specific to their complications (algorithm 1). (See 'Uncomplicated versus complicated diverticulitis' above.)
Treatment of diverticulitis — Inpatient treatment of acute diverticulitis typically begins with administration of intravenous antibiotics, fluids, and pain medications. Patients can be made nil per os to allow for complete bowel rest or be offered a clear liquid diet depending upon their clinical status. Patients without complications typically show a clinical response within two to three days, at which point their diet can be advanced further. Patients who continue to improve are discharged to complete a course of oral antibiotics; those who fail to improve are referred for surgical evaluation.
Intravenous antibiotics — Patients requiring hospitalization should begin intravenous antibiotics with activities against gram-negative rods and anaerobic organisms. The choice of agents depends upon the severity of the illness (table 2 and table 3). In rare occasions when acute diverticulitis develops in patients who are already hospitalized or have undergone percutaneous drainage, antibiotic coverage should be broadened to also include nosocomial organisms (table 4). If a culture has been taken at the time of percutaneous abscess drainage or surgery, the antibiotic regimen should be revised based upon susceptibility results. Anaerobic coverage should be continued if polymicrobial infection is identified. Detailed discussion of antibiotic therapy for intra-abdominal infections can be found in another topic. (See "Antimicrobial approach to intra-abdominal infections in adults".)
Intravenous antibiotics should be continued until the inflammation is stabilized, evidenced by resolving abdominal pain and tenderness. This process typically takes three to five days. The patient is then transitioned to oral antibiotics (most commonly ciprofloxacin plus metronidazole or amoxicillin-clavulanate) to complete a 10- to 14-day course (inclusive of intravenous and oral antibiotic therapy). (See 'Oral antibiotics' below.)
The duration of intravenous antibiotic therapy in patients who undergo procedures for definitive source control (percutaneous abscess drainage or surgery) is discussed separately. (See "Antimicrobial approach to intra-abdominal infections in adults", section on 'Duration of therapy'.)
The need for intravenous antibiotics for acute uncomplicated diverticulitis treated as inpatient has been studied in two European trials and one Oceanic trial [19]:
●In the Swedish trial (AVOD), 623 patients with CT-confirmed uncomplicated left-sided diverticulitis were treated with or without antibiotics as inpatients [20]. Complication rates (1.9 versus 1.0 percent), hospital length of stay (three days in both groups), and recurrence rates (16 percent in both groups) were similar. Ten patients initially treated without antibiotics subsequently received antibiotics due to increasing abdominal pain, fever, or increasing C-reactive protein (CRP). A subsequent study, which followed 556 of the original participants for a median of 11 years, reported similar outcomes between the antibiotic and no-antibiotic groups in the rates of recurrences, complications, surgery for diverticulitis, and colorectal cancer [21].
●A second Dutch trial (DIABOLO) randomly assigned 528 patients with first-episode, CT-proven, left-sided acute diverticulitis to observation or 10 days of antibiotics (Augmentin in most, ciprofloxacin plus metronidazole in the rest) [22]. Patients with complicated diverticulitis, with the exception of a small (<5 cm) abscess, were excluded. Most (93 percent) of the trial participants were admitted to the hospital. The median times to recovery without (14 [interquartile range 6 to 35] days) or with antibiotics (12 [7 to 30] days) were similar. At six months, the outcomes were similar in terms of complicated diverticulitis (3.8 percent observation versus 2.6 percent antibiotics), smoldering diverticulitis (7.3 versus 4.1 percent), recurrent diverticulitis (3.4 versus 3 percent), need for sigmoid resection (3.8 versus 2.3 percent), need for readmission (17.6 versus 12.0 percent), adverse events (48.5 versus 54.5 percent), or mortality (1.1 versus 0.4 percent).
●A double-blind, placebo-controlled Australian/New Zealand trial (STANDARD) randomly assigned 180 patients with CT-proven uncomplicated diverticulitis to either intravenous cefuroxime/Flagyl followed by Augmentin or placebo for seven days [23]. All patients were initially admitted to the hospital. There was no significant difference in hospital stay (40 hours antibiotics versus 46 hours placebo), adverse event rate, or 7- or 30-day readmission rate.
Given that these trials used different exclusion criteria, CT imaging is not perfect in detecting complicated diverticular disease, and most patients admitted for inpatient treatment of acute diverticulitis have either severe disease or serious comorbid conditions, we suggest treating all inpatients with antibiotics rather than selectively based on whether the disease is complicated. This issue remains controversial [24,25], however, particularly between providers based in Europe versus North America [26,27].
Intravenous fluid — Patients who are admitted for inpatient treatment of acute diverticulitis should be given intravenous fluid (eg, Ringer lactate or normal saline) to correct volume deficits. Intravenous fluid is typically continued until patients are tolerating adequate liquids.
Pain control — Patients who are admitted for acute diverticulitis often have severe abdominal pain from localized peritonitis. For such patients, parenteral analgesics (eg, acetaminophen, ketorolac, morphine, or hydromorphone) are administered when patients are taking nothing by mouth, while oral analgesics (eg, acetaminophen, ibuprofen, oxycodone) are appropriate when patients are consuming an oral diet.
Inpatient diet — Patients requiring hospitalization should initially be kept on complete bowel rest with intravenous hydration. Patients without complications typically show a clinical response within two to three days, at which point they can be started on a liquid diet and advanced as tolerated.
Treatment of complications — Of the acute complications of diverticulitis, abscesses and microperforations are quite common. Frank perforation is not common, and obstruction and fistulization are rare.
Frank perforation — Evidenced by free air under the diaphragm with or without extravasation of contrast or fluid, frank perforation of the colon results in diffuse peritonitis from intra-abdominal spread of feculent fluid and bacterial organisms. Acute diverticulitis that presents with frank perforation is life-threatening and mandates emergency surgery [28-31]. (See "Acute colonic diverticulitis: Surgical management", section on 'Perforation with generalized peritonitis'.)
Microperforation — Microperforation, also called contained perforation, is the presence of a small amount of air bubbles but no oral contrast outside of the colon on abdominopelvic CT imaging. Most patients who have microperforation should be treated initially with intravenous antibiotics (see 'Treatment of diverticulitis' above); the majority of them (94 percent) can be managed nonoperatively [32], but with the following caveats:
●Patients with pericolonic air bubbles only can be managed the same way as those with uncomplicated diverticulitis. The success rate of nonoperative management is from 85 to 99 percent [33,34]. (See 'Treatment of diverticulitis' above.)
●Patients with pericolonic air bubbles associated with an abscess should be managed according to the abscess. The expected success rate of nonoperative management is lower than that of uncomplicated diverticulitis. (See 'Abscess' below.)
●Patients with a small amount of distant intraperitoneal air bubbles (eg, over the liver, under the diaphragm) or distant retroperitoneal air bubbles require an individualized approach; those with a benign abdominal examination and absence of immunosuppression may be managed nonoperatively while those with peritonitis or on significant immunosuppression should undergo surgery. In these patients, the success rate of nonoperative management varies from 34 to 93 percent, depending on whether there is an associated abscess or pelvic fluid [7,33,35,36]. (See "Acute colonic diverticulitis: Surgical management", section on 'Perforation with generalized peritonitis'.)
Abscess — Abscesses occur in 16 to 40 percent of patients with complicated acute diverticulitis [37]. We suggest a stepwise approach to treating diverticular abscesses [27]:
●Antibiotics are the first-line treatment for all diverticular abscesses, particularly those <4 cm. (See 'Intravenous antibiotics' above.)
●Percutaneous drainage may be added, if feasible, for abscesses ≥4 cm, those that do not resolve with antibiotic therapy, or in the presence of clinical deterioration. (See 'Large abscess (≥4 cm)' below.)
The guidelines from the American Society of Colon and Rectal Surgeons (ASCRS) also advocate a stepwise approach to treating diverticular abscesses, but with a different cutoff size of 3 cm for recommending percutaneous drainage [12]. This discrepancy may not be clinically significant.
The overall success rate of nonoperative management for diverticular abscess is approximately 80 percent regardless of approach (antibiotics, percutaneous drainage, or both) [37]. The remaining 20 percent need surgery [38].
The recurrence rate after successful nonoperative management is 15 to 25 percent [37,39] and is higher for abscesses >5 cm [40]. Whether all asymptomatic patients with a healed diverticular abscess require elective surgery is controversial and discussed elsewhere. (See "Acute colonic diverticulitis: Surgical management", section on 'Healed diverticular abscess'.)
Small abscess (<4 cm) — For smaller abscesses, antibiotic therapy alone and percutaneous drainage have similar success rates, morbidity, and mortality [37]. One study that treated 23 abscesses <3 cm with antibiotics alone reported a treatment failure rate of 0 percent [38]. In another study, 93 of 107 diverticular abscesses <4 cm were successfully treated with antibiotics alone [41].
Patients who respond to antibiotics are followed with serial CT scans until the resolution of the abscess; patients who deteriorate or fail to improve after two to three days of antibiotic therapy may require surgery if percutaneous drainage is not an option.
Abscesses may not be amenable to percutaneous drainage because they are too small (ie, <2 cm) or there are important structures (eg, small bowel) adjacent to them that preclude percutaneous access [38,40,42].
Large abscess (≥4 cm) — The benefit of percutaneous drainage is greater for larger abscesses. As the size of the abscess increases from ≤3 cm to 3 to 10 cm and 3 to 18 cm, the success rate of antibiotics-alone therapy decreases from 100 to 82 and 66 percent, respectively [37]. By contrast, 80 percent of diverticular abscesses >4 cm resolve after percutaneous drainage [27]. In order to maximize the success rate of nonoperative management, we suggest percutaneous drainage of diverticular abscesses ≥4 cm, whenever feasible, in addition to antibiotic therapy.
CT-guided drainage is performed for abscesses that are amenable to percutaneous drainage. An approach through the anterior abdominal wall is favored for most abscesses, while abscesses deep in the pelvis or obscured by other organs are drained transgluteally. Transrectal or transvaginal approaches to abscess drainage have also been described but are rarely used [43,44]. Once a drainage catheter is placed, it is left until the output is minimal, a process that can take a longer course [45].
After percutaneous drainage of a diverticular abscess, patients typically defervesce within 24 to 48 hours. Surgical intervention should be considered for patients who do not improve within 48 hours. (See "Acute colonic diverticulitis: Surgical management".)
Obstruction — Patients with acute sigmoid diverticulitis can present with large bowel obstruction at the site of the acute inflammation. Rarely, the phlegmonous or abscess cavity can secondarily involve the small bowel causing a complete small bowel obstruction. (See "Acute colonic diverticulitis: Surgical management".)
Fistula — A fistula can develop between the colon and bladder, vagina, uterus, other bowel segments, and abdominal wall. Diverticular fistulas rarely close spontaneously, and a resection of the affected bowel segment is generally required. Though fistulization may also lead to intra-abdominal abscesses, these typically do not usually present acutely. The management of a diverticular fistula is discussed separately. (See "Diverticular fistulas".)
Subsequent care — Patients are assessed daily and typically show improvement after two to three days of antibiotics. Patients who show continued improvement can be discharged. Failure to improve should prompt repeat imaging.
Repeat imaging — Disease progression with or without new complications should be suspected in patients with clinical deterioration and those who fail to improve after two to three days of intravenous antibiotic therapy. Repeat imaging may be required in such patients.
The purpose of repeat imaging, typically with an abdominopelvic CT scan, is to look for new complications (eg, abscess or perforation) that may require further intervention (eg, percutaneous drainage or surgery).
Criteria for discharge — Most patients with uncomplicated diverticulitis have significant clinical improvement after two to three days of intravenous antibiotics. They are then reassessed daily to determine if they are eligible to be discharged from the hospital. The patient must meet all criteria listed below before they can be discharged:
●Normalization of vital signs (ie, resolution of high fever, tachycardia, or hypotension)
●Resolution of severe abdominal pain
●Resolution of significant leukocytosis
●Tolerance of oral diet
●Resumption of bowel movements
Oral antibiotics — Patients are discharged with oral antibiotics . We use one of the following oral antibiotic regimens in adult patients with normal renal and hepatic function (table 5):
●Amoxicillin-clavulanate (1 tablet [contains 875 mg amoxicillin and 125 mg clavulanic acid] every 8 hours) or amoxicillin-clavulanate extended-release (2 tablets [each tablet contains 1 g amoxicillin and 62.5 mg clavulanic acid] every 12 hours) [14,46,47]
●Ciprofloxacin (500 mg every 12 hours) plus metronidazole (500 mg every 8 hours)
●Levofloxacin (750 mg once daily) plus metronidazole (500 mg every 8 hours)
●Trimethoprim-sulfamethoxazole (1 double-strength tablet every 12 hours) plus metronidazole (500 mg every 8 hours)
The local antibiogram should be consulted to avoid prescribing a regimen to which bacterial resistance exceeds 10 percent. As an example, in areas where the prevalence of Escherichia coli resistance to fluoroquinolones exceeds 10 percent, amoxicillin-clavulanate or trimethoprim-sulfamethoxazole plus metronidazole are the preferred agents. Moxifloxacin is reserved for those who cannot use the other regimens because of high rates of resistance among anaerobes [48]. There is also clinical evidence that fluoroquinolones plus metronidazole were associated with a higher rate of Clostridioides difficile than amoxicillin-clavulanate at one year [49].
Most immunocompetent patients should complete a course of four to seven days (inclusive of both intravenous and oral antibiotics), except for those with an undrained abscess or phlegmon, who should receive 7 to 10 days of antibiotics. Immunocompromised patients should be treated with antibiotics for 10 to 14 days.
The optimum duration of antibiotic therapy for various forms of diverticulitis has not been well studied. One small trial showed that the outcomes of four and seven days of intravenous antibiotics were similar for uncomplicated diverticulitis, although such patients probably did not require antibiotic therapy [50]. The current recommendations for a shorter duration are based on expert opinions rather than clinical data [51-54]. Thus, the actual duration should be tailored to individual patients based on how quickly they improve and whether source control has been achieved.
After discharge, patients should be reassessed within one week and then weekly until all symptoms have resolved. Patients with a microperforation or undrained abscess/phlegmon are particularly prone to recurrence and thus require vigilant follow-up. In a retrospective cohort study of over 200,000 patients, the readmission rate for treatment failure was 6.6 percent, with complicated diverticulitis being the strongest predictor of readmissions [55]. (See "Acute colonic diverticulitis: Outpatient management and follow-up".)
Failure of inpatient medical treatment — Surgical evaluation is indicated at any point during admission if the patient's condition deteriorates (eg, increased abdominal pain or leukocytosis, or development of diffuse peritonitis). (See "Acute colonic diverticulitis: Surgical management".)
Patients who fail to improve with two to three days of intravenous antibiotics should undergo repeat imaging to identify new-onset complications of diverticulitis (eg, abscess or perforation). Certain complications may require surgery. (See 'Repeat imaging' above and 'Treatment of complications' above.)
In addition, surgery may be warranted in patients who fail to improve after another one to two days of medical management, even if no complications are identified with repeat imaging.
SPECIAL PATIENT GROUPS
Young patients (age <40) — Although some studies have reported more frequent and severe recurrences in patients younger than 40 years of age and some have advocated early elective surgery in such patients [56-60], other studies have suggested that the risk of recurrence is better predicted by the severity of the initial attack than the age of onset [61,62]. In concordance with the American Society of Colon and Rectal Surgeons (ASCRS) practice parameters for sigmoid diverticulitis, we do not offer elective surgery to patients who have a history of diverticulitis simply because they are young [12].
Right-sided (cecal) diverticulitis — In Western countries, acute colonic diverticulitis is primarily left sided (72 percent sigmoid, 33 percent descending, 3 percent transverse, 5 percent ascending colon). Right-sided (cecal) diverticula account for only 1.5 percent of diverticulitis cases in Western countries but 38 to 75 percent of diverticulitis cases in Asian countries [63].
Patients with right-sided diverticulitis tend to be younger than those with left-sided disease [64]. Right-sided diverticulitis is less likely to be complicated. Several studies from both Western and Asian countries have reported lower complication rates, lower mortality rates, and lower recurrence rates to be associated with right-sided, as compared with left-sided, diverticulitis [64,65].
The management of right-sided diverticulitis ranges from medical therapy to surgery, depending upon patient presentation. When the diagnosis is made nonoperatively, medical management with antibiotics is usually sufficient. In a systematic review and meta-analysis of 11 studies, the pooled recurrence rate after nonoperative management was 12 percent (95% CI 10 to 15 percent) with a median follow-up of 34 months [66]. Only 10 percent of those who recurred required urgent surgery at the first recurrence, and there was no mortality.
Patients who are diagnosed with right-sided diverticulitis during exploratory operations for abdominal discomfort can undergo an appendectomy if the base of the appendix and the cecum are not inflamed [67-69]. This is then followed by antibiotic therapy. Diverticulectomy can be performed if there is a localized perforation of the involved diverticulum [67,70]. One prospective nonrandomized study associated diverticulectomy with similar success and complication rates but lower recurrence rates than medical management [71]. Most commonly, a right hemicolectomy is performed if there is inflammation of the area or a mass suggestive of a carcinoma [69].
SOCIETY GUIDELINE LINKS —
Links to society and government-sponsored guidelines from selected countries and regions around the world are provided separately. (See "Society guideline links: Colonic diverticular disease" and "Society guideline links: Intra-abdominal infections in adults".)
INFORMATION FOR PATIENTS —
UpToDate offers two types of patient education materials, "The Basics" and "Beyond the Basics." The Basics patient education pieces are written in plain language, at the 5th to 6th grade reading level, and they answer the four or five key questions a patient might have about a given condition. These articles are best for patients who want a general overview and who prefer short, easy-to-read materials. Beyond the Basics patient education pieces are longer, more sophisticated, and more detailed. These articles are written at the 10th to 12th grade reading level and are best for patients who want in-depth information and are comfortable with some medical jargon.
Here are the patient education articles that are relevant to this topic. We encourage you to print or e-mail these topics to your patients. (You can also locate patient education articles on a variety of subjects by searching on "patient info" and the keyword(s) of interest.)
●Basics topics (see "Patient education: Diverticulitis (The Basics)")
●Beyond the Basics topics (see "Patient education: Diverticular disease (Beyond the Basics)")
SUMMARY AND RECOMMENDATIONS
●Complicated versus uncomplicated diverticulitis – Acute complications of colonic diverticulitis include:
•Abscess (common)
•Perforation (common)
•Obstruction (rare)
•Fistulization (rare)
The need for surgical intervention is much higher for complicated diverticulitis than for uncomplicated diverticulitis. (See 'Uncomplicated versus complicated diverticulitis' above.)
●Decision on outpatient versus inpatient care – Based upon findings on the history, physical examination, laboratory tests, and abdominopelvic CT scan, patients with acute colonic diverticulitis are triaged to either inpatient or outpatient treatment. Inpatient care is indicated for those with (algorithm 1):
•Complicated diverticulitis (ie, perforation, abscess, obstruction, or fistula), and/or
•Risk factors for worse outcomes as an outpatient (table 1)
Patients without these risk factors have similar outcomes regardless of care setting. (See 'Triage' above.)
●Treating diverticulitis – For patients in whom inpatient management of acute colonic diverticulitis is appropriate, we suggest administering intravenous antibiotics (Grade 2C). Some of these patients have clear indications for antibiotics (eg, abscess), and there is no evidence that uncomplicated but severe diverticulitis can be treated without antibiotics.
The choice of agents depends on disease severity and risk factors for antibiotic resistance or treatment failure (eg, advanced age, major medical comorbidities, immunocompromise, travel to areas with resistant organisms):
•Mild to moderate symptoms without risk factors (table 2)
•Severe symptoms and/or risk factors (table 3)
•Hospital-acquired infection (table 4)
Patients should initially be kept on complete bowel rest. Clinical response is typically seen within two to three days, at which point a liquid diet can be started and advanced as tolerated. Immunocompetent patients who continue to improve are discharged with oral antibiotics to complete a total of four to seven days of antibiotic therapy (7 to 10 days for undrained abscess or phlegmon) (table 5). Immunocompromised patients should be treated with antibiotics for 10 to 14 days. (See "Acute colonic diverticulitis: Outpatient management and follow-up".)
Patients who fail to improve with inpatient treatment may require repeat imaging and/or surgical evaluation. (See 'Treatment of diverticulitis' above and "Acute colonic diverticulitis: Surgical management".)
●Treating complications – Patients with complicated diverticulitis must receive intravenous antibiotics and undergo treatments specific to their complications. Diverticular abscesses ≥4 cm require percutaneous drainage if feasible; smaller abscesses may respond to antibiotics alone. Sigmoid colectomy is the preferred treatment for frank perforation, obstruction, or fistulization. (See 'Treatment of complications' above and "Acute colonic diverticulitis: Surgical management".)
ACKNOWLEDGMENT —
The editorial staff at UpToDate acknowledge Tonia Young-Fadok, MD, and John H Pemberton, MD, who contributed to earlier versions of this topic review.
