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Source created 2026-08-25 · updated 2026-08-25
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ASCRS Ch38 - Colonic Diverticular Disease

Chapter 38, "Colonic Diverticular Disease," ASCRS Textbook of Colon and Rectal Surgery, 4th edition. Authors: J.F. Hall and W.A. Bemelman. Book pp. 665–680 (title page through References).

Textbook reference chapter (not primary literature). A comprehensive single-chapter treatment of diverticular disease — epidemiology/pathophysiology, diagnostic evaluation, medical and surgical management across the Hinchey spectrum, special populations, fistula/obstruction, and technical aspects of surgery. Substantially deepens the wiki's existing Diverticulitis page (previously built mainly from Sabiston Ch52 - Diverticular Disease, Obstruction & Pseudo-Obstruction plus two individual RCT source pages), and adds diverticular-adjacent technical detail (IMA preservation, splenic flexure mobilization outcomes, ureteral stents, anastomotic leak testing) that enriches Anastomotic Construction.

Structure

  • Epidemiology, pathophysiology, and risk factors: histology/pathology, role of dietary fiber, genetics/microbiome, risk factors (diet, obesity, physical activity, smoking, NSAIDs).
  • Clinical presentation and differential diagnosis; symptomatic uncomplicated diverticular disease (SUDD).
  • Diagnostic evaluation: labs (CRP, procalcitonin, fecal calprotectin — limited evidence base); CT imaging (first-line modality, Ambrosetti mild/severe classification, the modified CT-based Hinchey reclassification — grades 0/1a/1b/2/3/4); endoscopic evaluation (timing, malignancy yield).
  • Management of acute uncomplicated diverticulitis: antibiotics controversy (DIABOLO, AVOD trials), ambulatory management, dietary changes.
  • Management of acute complicated diverticulitis: diverticular abscesses (Hinchey Ib/II); Hinchey III nonoperative management; laparoscopic lavage (LOLA, SCANDIV, DILALA trials, with a comparative 1-year outcomes figure); Hinchey IV diverticulitis; sigmoidectomy with anastomosis vs. Hartmann's procedure (cohort data, inclusion/exclusion criteria across four RCTs).
  • Chronic diverticular disease: elective surgery timing/indications (incl. the DIRECT trial); special populations (the young, the immunocompromised); fistula (colovesical, colovaginal, colocutaneous); obstruction.
  • Technical aspects of surgery: approach (laparoscopy evidence), transection margins, IMA preservation, splenic flexure mobilization, ureteral stents, anastomotic leak testing, right-sided diverticulitis.
  • Conclusion: individualized assessment is the key to surgical decision-making; the field continues to shift toward less invasive/nonoperative management where evidence supports it.

Open items / gaps

  • DIABOLO, AVOD, DILALA, and DIRECT are all cited here at the textbook/secondary level only — none independently ingested from primary literature yet. See Diverticulitis's Open items for the consolidated list.
  • The chapter reads (through book p. 680); Chapter 39 ("Large Bowel Obstruction," Feingold DL, Fleming FJ) begins immediately after — not yet read/ingested.