Definitive sigmoid resection Fulvestrant order requires mobilization of the sigmoid colon with avoidance of injury to the ureters. Ureteral stents should be used selectively in those patients with abscesses or

excessive inflammation in the pelvis. For definitive resection the distal margin of resection should be the upper rectum [63] while the proximal margin of resection should go back to non-inflamed descending colon. All diverticuli do not need to be resected. The splenic flexure is generally not mobilized unless needed to form colostomy when indicated. As previously discussed, the major debate is whether to perform a PRA or a HP. A variety of factors need to be considered including a) disease severity b) condition of bowel at the site of anastomosis, c) patient physiology, d) nutritional status, e) patient co-morbidities, f) hospital/situational factors and g) surgeon experience. Another unresolved debate is should a protecting diverting ileostomy be added if a PRA is performed? Unless conditions are optimal, this is the prudent option. The use of perioperative colonic lavage appears to lower complications with PRA, but the supporting evidence is limited [64]. Omentoplasty does not offer any benefits [65]. The inferior mesenteric artery should be preserved when feasible to lower the risk of an anastomotic

leak [66]. Discharge and follow-up Although there is lack of evidence that lifestyle changes will help prevent recurrent diverticulitis, it is likely that measures thought to prevent an initial episode of diverticulitis would also apply to

preventing selleck products a recurrence. These healthy lifestyles should be recommended upon discharge and include a) physical exercise, b) a high fiber diet, c) reduced red meat, d) minimize alcohol consumption and e) stop smoking [67, 68]. Patients should return to the clinic if symptoms recur and have a follow-up clinic appointment at four to six weeks to address three issues. Colonoscopy After the inflammation from a new onset of diverticulitis has resolved, traditionally patients have undergone colonoscopy to rule out colon cancer. However, the need for Methamphetamine routine colonoscopy has recently been questioned [69]. Colonoscopy is a time-consuming and a resource burden on an already-stretched health care system. In addition, endoscopy may be technically more difficult in these patients with an risk iatrogenic bowel perforation (~0.1%). The reported incidence of colon cancer in CT diagnosed acute diverticulitis ranges from 0.5 to 3%. But with technological improvement in quality and resolution of CT has led to better evaluation of the colon in the affected segment and the chances of missing a colon cancer has decreased. A recent study by Sallinen et al. provides additional insight into this debate [70].