What is the treatment for perforated diverticula?

From the Guidelines

The treatment for perforated diverticula typically involves surgical intervention, with options including open or laparoscopic small bowel segmental resection and primary anastomosis, or resection and stoma creation, depending on the patient's condition and the severity of the perforation. The management of perforated diverticula requires a comprehensive approach, considering the patient's overall health, the extent of the perforation, and the presence of any complications. According to the most recent guidelines, antibiotic therapy plays a crucial role in the management of perforated diverticula, with a recommended duration of 4 days in immunocompetent patients and up to 7 days in immunocompromised or critically ill patients, if source control is adequate 1.

The choice of antibiotic regimen should be based on the underlying clinical condition of the patient, the pathogens presumed to be involved, and the risk factors for major antimicrobial resistance patterns 1. The treatment options for perforated diverticula include:

• Open or laparoscopic small bowel segmental resection and primary anastomosis
• Resection and delayed anastomoses at a second look, in cases of perforation due to small bowel ischemia
• Open or laparoscopic resection and stoma creation, or exteriorization of the perforation as a stoma, in critically ill patients or those with severe inflammation and edema of the bowel.

It is essential to note that patients who have ongoing signs of infection or systemic illness beyond 7 days of antibiotic treatment warrant a diagnostic investigation 1. The management of perforated diverticula requires a multidisciplinary approach, involving surgeons, infectious disease specialists, and other healthcare professionals, to ensure the best possible outcomes for patients.

From the Research

Treatment Options for Perforated Diverticula

• The treatment for perforated diverticula can vary depending on the location and severity of the condition, as well as the overall health of the patient 2, 3, 4, 5.
• Conservative therapy with antibiotics and bowel rest is often successful in treating perforated diverticula, but surgical management may be necessary if conservative therapy fails 2, 5.
• Surgical options for perforated diverticula include:
  • Simple diverticulectomy
  • Segmental resection
  • Duodenal exclusion/bypass
  • Pancreatoduodenectomy (in cases of complicated duodenal diverticulum) 2, 3, 5
• Video laparoscopy can also be used to treat perforated epiphrenic diverticulum, with diverticulectomy and manual and mechanic suture being a possible approach 4.
• The decision to operate or not depends on a combined subjective, clinical, and radiological assessment of the patient, taking into account the stage of the disease, the patient's general condition, and the availability of facilities and personnel for intensive care 3, 5.

Medical Therapeutic Management

• For patients with severe and complicated diverticulitis, antibiotics such as ampicillin, gentamicin, metronidazole, piperacillin, and tazobactam can be used 6.
• For uncomplicated diverticular disease, ciprofloxacin, metronidazole, and rifaximin have been successfully used 6.
• Mesalazine and probiotics are also being developed as therapies for the treatment of diverticulitis, with promising results in improving symptoms and preventing recurrence 6.