Diverticulitis in the Elderly Clinical Practice Guidelines (2022, WSES/SICG/ACOI/SICUT/AcEMC/SIFIPAC)

World Society of Emergency Surgery, Italian Society of Geriatric Surgery, Italian Hospital Surgeons Association, et al

These are some of the highlights of the guidelines without analysis or commentary. For more information, go directly to the guidelines by clicking the link in the reference.

February 01, 2022

Clinical practice guidelines on the diagnosis and treatment of diverticulitis in the elderly by the World Society of Emergency Surgery (WSES), the Italian Society of Geriatric Surgery (SICG), the Italian Hospital Surgeons Association (ACOI), the Italian Emergency Surgery and Trauma Association (SICUT), the Academy of Emergency Medicine and Care (AcEMC), and the Italian Society of Surgical Pathophysiology (SIFIPAC) were published in January 2022 in the World Journal of Emergency Surgery.[1]


Computed tomography (CT) with intravenous contrast is suggested for elderly patients with suspected acute left colonic diverticulitis, who present with abdominal guarding or pain in the lower left abdomen. This recommendation is made irrespective of the white blood cell count or C-reactive protein level. For patients with contrast allergy or severe kidney disease, ultrasonography, magnetic resonance imaging, and CT without contrast are alternative diagnostic studies.


Conservative treatment without antibiotics is the suggested approach for immunocompetent elderly patients who have uncomplicated left colonic diverticulitis (WSES stage 0).

Antibiotic therapy is appropriate for elderly patients who have localized complicated left colonic diverticulitis with pericolic air bubbles or a small amount of pericolic fluid without abscess (WSES stage 1a).

For patients who have an abscess from acute left colonic diverticulitis (WSES stage 1b-2a) but no peritonitis, broad-spectrum antibiotic therapy is suggested. If the abscess is larger than 4 cm (WSES stage 2a), percutaneous drainage should also be performed. Culture of the drainage is recommended to guide antibiotic therapy.

If CT reveals intraperitoneal free air in elderly patients with acute left colonic diverticulitis (WSES stage 2b), surgical exploration is suggested.

For elderly patients with acute diverticulitis and diffuse peritonitis (WSES stage 3-4), immediate fluid resuscitation, antibiotic treatment, and surgery are required.

Elective sigmoid resection may be considered for elderly patients with fistulae, stenosis, or recurrent diverticular bleeding, as well as for those who are immunocompromised or highly symptomatic.

For more information, please go to Diverticulitis.


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