COMPLICATED ACUTE DIVERTICULITIS: SURGICAL INDICATIONS IN THE FACE OF CLINICAL TREATMENT FAILURE

Resumen

 Acute diverticulitis is a frequent gastrointestinal emergency, and although most episodes are uncomplicated and resolve with conservative measures, a clinically relevant subgroup develops complicated disease or fails non-operative management, raising the question of when surgical intervention becomes necessary. This narrative review aimed to critically analyse the surgical indications for complicated acute diverticulitis when clinical treatment fails, integrating current guidelines and randomised evidence. A search of PubMed/MEDLINE, SciELO, LILACS, the Cochrane Library and Google Scholar was performed using descriptors related to diverticulitis, peritonitis and surgical management, prioritising publications from the last fifteen years without excluding landmark works. The literature indicates that clinical failure encompasses clinical deterioration, sepsis, free perforation with diffuse peritonitis and abscesses not amenable to or unresponsive to percutaneous drainage. Image-guided drainage and antibiotics manage most contained abscesses, whereas emergency resection remains the reference for diffuse peritonitis. Randomised trials support sigmoidectomy with primary anastomosis over Hartmann's procedure in selected stable patients, while laparoscopic peritoneal lavage has shown inconsistent results. In conclusion, the surgical decision should be individualised according to haemodynamic status, peritoneal contamination, comorbidities and local expertise, and further studies are needed to refine patient selection.