When should surgery be offered for uncomplicated acute diverticulitis? What is laparoscopic peritoneal lavage?
The classic surgical tenet that patients with two or more attacks should undergo colectomy has been challenged, as has the concept that patients at the ends of the age spectrum should have more aggressive surgical intervention. Newer data suggests that it is safe to consider intervention on a case-by-case basis and offer colectomy based on symptoms. Free perforation with peritonitis, bowel obstruction, and severe bleeding are indications for immediate surgery. Catheter drainage of a localized abscess can often postpone surgery and may often obviate the need for acute colostomy formation (Hartmann procedure) or allow a laparoscopic approach.
Peritoneal lavage or washout consists of a laparoscopic procedure to wash out the abdominal cavity in the setting of purulent (not feculent) peritonitis caused by acute diverticulitis. Saline is used to irrigate the abdomen and drains are placed. Several large-scale prospective studies are under way to assess whether this procedure can reduce overall colectomy and morbidity rates.