For patients who have stage III and stage IV disease and concerning signs of sepsis but are not in septic shock also need source control. While traditionally these patients were taken expeditiously selleck compound to the OR for a HP or a PRA, we believe that the recent case series indicate that LLD is a viable option that should be employed to low risk patients but recommend a definitive sigmoid resection for high risk that include patients who are a) immunocompromised, b) have severe co-morbidities c) organ dysfunctions attributable to ongoing sepsis or d) stage IV disease. The again

the decision to perform an anastomosis should be individualized based on the current physiology, the condition of bowel, patient co-morbidities, and surgeon experience. Patients who do not require an emergency operation Initial recommended treatment of stage IA and IB diverticulitis includes a) nil per os (NPO), b) nasogastric tube to treat (if present) symptoms of nausea, vomiting and abdominal distention and c) antibiotics with activity against common gram-negative and anaerobic pathogens. A number of single agents and combination regimens provide such activity. However, there is little LGK974 evidence on which to base selection of specific antimicrobial

PXD101 mw regimens, and no regimen has demonstrated superiority [56, 57]. In general, episodes of diverticulitis severe enough to warrant hospitalization should be initially managed with IV antibiotics. Oral antibiotic

therapy can be started when the patient’s condition improves and continued as outpatient treatment. There is a paucity of data regarding the optimal duration of antimicrobial therapy. Patients with stage II diverticulitis should be managed as above but should also be evaluated by interventional radiology for CT guided PCD[51]. The preferred approach Racecadotril is trans-abdominal either anterior or lateral, attempting to avoid the inferior epigastric or deep circumflex iliac vessels. Other approaches include transgluteal, transperineal, transvaginal or transanal. Reported failure rates for PCD range from 15% to 30% with a complication rate of 5% (including bleeding, perforation of a hollow viscous or fistula formation) [58–60]. Observation Patients with stage IA, IB and II diverticulitis should be treated as described above and observed with serial a) physical exams, b) assessments of SIRS severity and c) laboratory evidence organ dysfunctions. It is expected that their clinical condition will improve over 72 hours. If it does not improve or their condition worsens they should undergo an urgent operation. Patients who resolve their symptoms should be discharged to home on oral antibiotics with follow-up (described below). Patients who fail observation These patients should undergo definitive sigmoid resection.