Behandeling van diverticulitis

• Uncomplicated diverticulitis does not routinely require antibiotic treatment and can even be managed in the outpatient setting.
• As yet no medical therapies have proven themselves useful in the prevention of recurrence.
• Complicated diverticulitis with an abscess smaller than 4 cm is treated with antibiotics, larger abscesses are treated by percutaneous drainage, and only if treatment fails surgery is required.
• Laparoscopic lavage is no better than partial resection in purulent peritonitis.
• Perforated diverticulitis with faecal peritonitis is treated by a Hartmann’s procedure; in selected cases resection and primary anastomosis may be considered.
• The decision whether a resection should be laparoscopic or open is based on the surgeon’s experience.
• The choice for elective resection for recurrent diverticulitis is still made on a patient-by-patient basis.
• Only high-risk patients should have a follow-up colonoscopy to exclude malignancy. The remaining patients are referred back to the Dutch national colorectal cancer screening programme.

Conflict of interest and financial support: none declared.