Diverticulitis - Indications for Surgery

Strong Evidence for Surgery:
- Diffuse peritonitis
- Free perforation
- Fistula
- Stricture
- Obstruction
- Immunocompromised patient
- >= 4 uncomplicated episodes

Conflicting Evidence for Surgery:
- After abscess drainage
- Uncomplicated, 2 or 3 episodes

Surgery No Longer Supports Surgery:
- Uncomplicated 1st episode
- Age <50

Broderick-Villa G, 2005: Large retrospective review examining pts with recurrent diverticulitis.  After conservative treatment, few (13%) recurred and most of these recurrences were managed conservatively again.