Special Situations in the Management of Colonic Diverticular Disease

Guidelines for the treatment of diverticular disease remain nebulous. More recent data question previous recommendations for aggressive surgical resection in recurrent uncomplicated diverticulitis. These data also question the link between worsening diverticular disease and recurrence or young age. In fact, recent data suggest a less virulent disease in patients <50 years and thus these young patients may be managed similarly to that of older cohorts. Today, guidelines from the American Society of Colon and Rectal Surgeons recommend an individualized approach to uncomplicated disease with consideration for nonoperative management over surgery. In this review, we present several controversial but evolving issues regarding the management of recurrent diverticulitis as well as diverticular disease in the young (<50 years). In addition, we detail the incidence, pathophysiology, clinical presentation, and management of less common presentations of diverticular disease.