**1. Introduction**

Diverticular disease is a common and increasing cause of emergency consultation in Western countries with 3–5 cases per 100,000 habitants. Although in most cases it remains asymptomatic, roughly 20% may require emergency treatment. The advances both in image quality of new multi-slice CT scans and laparoscopic procedures have influenced changes in the way we treat these complicated patients. Complications of sigmoid diverticulitis due to acute inflammation and colonic wall perforation may manifest as pericolic (Hinchey I) or extra-mesocolic (Hinchey II) abscesses, and purulent (Hinchey III) or fecal peritonitis (Hinchey IV). Although the first two are managed conservatively, treatment for stages III/IV is not that straightforward. We will refer to Hinchey III/IV acute diverticulitis as complicated acute diverticulitis (CAD) [1–3].

The clinical and surgical approach to CAD differs basically on the physiological status of the presenting patient [4].

Fortunately enough, even if CAD is, by definition, severe sepsis, a good proportion of the patients are not in septic shock at presentation. This means that they are still in a physiological state to tolerate a definitive "classical" procedure. Standard surgical therapy for CAD has been to perform either an open or laparoscopic resection, followed by a primary anastomosis or a protected anastomosis or a terminal colostomy. The latter is still the most common procedure. In recent years, a less invasive approach has been used to fit patients with Hinchey III peritonitis. In these cases, a laparoscopic lavage and drainage (LLD) seem to be, according to a growing number of surgeons, a safe option [1–6].

In this chapter, we will not linger any longer on these previous strategies.

We will focus only on the smaller group of patients with CAD who present with such an advanced derangement of their physiology that needs to be treated in a Damage Control Modality.

Damage Control, in our view, is not merely a surgical technique. It is in fact, a strategy of treatment brought forward by a close collaboration between different specialties, among which surgery, intensive care (ICU) and anesthesia play a significant role. Thus, we will present the input on each of these specialties on the therapeutic strategy.
