Intended for healthcare professionals

Clinical Review State of the Art Review

Management of colonic diverticulitis

BMJ 2021; 372 doi: (Published 24 March 2021) Cite this as: BMJ 2021;372:n72
  1. Anne F Peery, associate professor of medicine
  1. University of North Carolina School of Medicine, Chapel Hill, NC 27599-7555, USA
  1. Anne_Peery{at}


Left sided colonic diverticulitis is a common and costly gastrointestinal disease in Western countries, characterized by acute onset of often severe abdominal pain. Imaging is necessary to make an initial diagnosis and determine disease severity. Colonoscopy should be done six to eight weeks after diagnosis to rule out a missed colon malignancy. Antibiotic treatment is used selectively in immunocompetent patients with mild acute uncomplicated diverticulitis. The clinical course of diverticulitis commonly includes unpredictable recurrences and chronic gastrointestinal symptoms, which are a detriment to quality of life. A better understanding of prognosis has prompted a shift toward non-operative approaches. The decision to undergo prophylactic colon resection should be individualized to consider the severity of diverticulitis, the patient’s health and immune status, and the patient’s preferences and values, as well as benefits and risks. Because only a section of colon is removed, recurrent diverticulitis remains a risk. Acute diverticulitis with an abscess is treated with antibiotics that cover Gram negative and anaerobic bacteria, with or without percutaneous drainage. Acute diverticulitis with purulent or feculent contamination of the peritoneal cavity is managed with surgery; primary resection and anastomosis is the procedure of choice in stable patients.


  • Series explanation: State of the Art Reviews are commissioned on the basis of their relevance to academics and specialists in the US and internationally. For this reason they are written predominantly by US authors

  • Contributors: AP reviewed the literature and wrote this review. She is the guarantor.

  • Funding: This research was supported in part by a grant from the National Institutes of Health K23DK113225 and NIH R01DK094738.

  • Competing interests: I have read and understood the BMJ policy on declaration of interests and declare the following interests: None

  • Provenance and peer review: Commissioned; externally peer reviewed.

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