- 1-2 resection and immediate anastamosis are suitable.
In setting of perforated, peritonitic diverticulitis, resection with diversion is gold standard.
- other potential options (without great evidence) include on-table lavage and primary anastamosis (more for obstructing colon lesions with minimal contamination), laparoscopic lavage and creation of loop ileostomy (and delayed laparoscopic sigmoid resection)
- one stage resection: argument is that colostomy takedown and reanastamosis associated with 4% mortality and 30-40% never go back for reversal.
In a healthy patient mortality of 4% seems too high. In an elderly and sick patient primary anastamosis would carry too high risk of leak with attendant risks of getting sicker
- diversion: loop ileostomy vs. Transverse colostomy. Higher risk of obstruction with ileostomy but transverse colostomy associated with paying problems, scar issues and harder to reverse.
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